MEDICARE: SPECTRUM MRI FULL BODY IMAGING CENTER

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	291U00000X	Clinical Medical Laboratory	26965	CA

General Provider Information

NPI Number	:	1083739668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM MRI FULL BODY IMAGING CENTER

Provider Business Mailing Address
First Line	:	14365 PIPELINE AVENUE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14365 PIPELINE AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5642
Country	:	US
Telephone Number	:	909-591-5587
Fax Number	:	909-591-0538

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ARMIDA MENDOZA-GARCIA
Credential	:
Telephone Number	:	909-591-5587

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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