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General NPI Number Information
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NPI Number | 1730643651
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Entity Type | Organization
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Legal Business Name | PAHRUMP IMAGING LLC
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 1397 S LOOP RD
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City | PAHRUMP
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State | NV
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Zip | 89048-4729
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Country | US
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Telephone | 775-771-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 5384 SPLENDIDO AVE
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City | PAHRUMP
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State | NV
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Zip | 89061-0144
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Country | US
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Telephone | 310-408-0227
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARIANNE HAZELITT
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Credential | DO
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Telephone | 310-408-0227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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