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General NPI Number Information
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NPI Number | 1689992380
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Entity Type | Organization
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Legal Business Name | BLUEBEAM RADIOLOGY PC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 3113 CORONADO DR
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City | FULLERTON
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State | CA
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Zip | 92835-1725
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Country | US
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Telephone | 562-245-7814
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Fax |
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Provider Business Mailing Address
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Address Line | 3113 CORONADO DR
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City | FULLERTON
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State | CA
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Zip | 92835-1725
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Country | US
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Telephone | 562-245-7814
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIKRAM M HATTI
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Credential | M.D.
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Telephone | 562-245-7814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A92712
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License Number State | CA
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