MEDICARE: IMAGE ONE A MEDICAL CORP

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	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1093585036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGE ONE A MEDICAL CORP

Provider Business Mailing Address
First Line	:	8787 COMPLEX DR STE 202
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1451
Country	:	US
Telephone Number	:	760-798-8855
Fax Number	:	760-755-5245

Provider Business Practice Location Address
First Line	:	8707 COMPLEX DRIVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	619-616-2100
Fax Number	:	619-616-2104

Authorized Official
Title or Position	:	CEO
Name	:	DR. MEHRAN MOUSSAVIAN
Credential	:	DO
Telephone Number	:	619-616-2100

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	06/16/2025

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Directions to “IMAGE ONE A MEDICAL CORP ” Practice Location

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