MEDICARE: BAY HARBOR MRI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TD062	OTHER	CA	PTAN
2	00A321511	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1083639843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY HARBOR MRI INC

Provider Business Mailing Address
First Line	:	1403 LOMITA BLVD
Second Line	:	SUITE 107
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-325-9901
Fax Number	:	310-325-0202

Provider Business Practice Location Address
First Line	:	1403 LOMITA BLVD
Second Line	:	SUITE 107
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-325-9901
Fax Number	:	310-325-0202

Authorized Official
Title or Position	:	OFFICE DIRECTOR
Name	:	MRS. TANIA M REYES
Credential	:	D.O.
Telephone Number	:	310-325-9901

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/21/2022

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Directions to “BAY HARBOR MRI INC ” Practice Location

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