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General NPI Number Information
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NPI Number | 1902003429
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA PORTABLE X-RAY &EKG
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 BAKER ST E STE.#110
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City | COSTA MESA
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State | CA
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Zip | 92626-4509
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Country | US
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Telephone | 714-979-2581
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Fax | 714-979-2584
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Provider Business Mailing Address
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Address Line | 125 BAKER ST E STE.#110
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City | COSTA MESA
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State | CA
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Zip | 92626-4509
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Country | US
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Telephone | 714-979-2581
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Fax | 714-979-2584
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL M ASALY
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Credential |
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Telephone | 714-979-2581
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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 | RHT41451
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License Number State | CA
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