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General NPI Number Information
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NPI Number | 1982724829
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MEDICAL IMAGING CENTER, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 11088 ELM AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7676
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Country | US
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Telephone | 909-625-2000
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Fax | 909-625-2099
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Provider Business Mailing Address
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Address Line | 11088 ELM AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7676
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Country | US
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Telephone | 909-625-2000
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Fax | 909-625-2099
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Authorized Official
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Title or Position | MEDICAL RADIOLOGIST
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Name | DR. CAMIAR OHADI
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Credential | MD
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Telephone | 909-625-2000
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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 | G798070
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License Number State | CA
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