=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679735310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRI DIAGNOSTICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2008
-----------------------------------------------------
Last Update Date | 07/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 598 N F ST
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92410-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-384-5430
-----------------------------------------------------
Fax | 909-889-0672
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 598 N F ST
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92410-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-384-5430
-----------------------------------------------------
Fax | 909-889-0672
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEORGE N ELIAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-384-5430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | A85846
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------