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General NPI Number Information
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NPI Number | 1629583091
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Entity Type | Organization
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Legal Business Name | PREMIUM MOBILE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 11414 W PARK PL STE 202
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City | MILWAUKEE
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State | WI
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Zip | 53224-3500
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Country | US
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Telephone | 951-272-3372
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 LOWRY RANCH RD
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City | CORONA
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State | CA
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Zip | 92881-4735
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Country | US
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Telephone | 951-272-3372
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ZINATH KHAN
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Credential | MBA
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Telephone | 951-272-3372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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