=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649886276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARLENE MOGAVERO RDMS, RVT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2020
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 S COLLEGE ST
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-7043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-686-6262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 RED OAK
-----------------------------------------------------
City | LIBERTY HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78642-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-621-3954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471S1302X
-----------------------------------------------------
Taxonomy Name | Sonography Radiologic Technologist
-----------------------------------------------------
License Number | 118388
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------