MEDICARE: MOBILE RADIOLOGICAL SERVICES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	367H00000X	Anesthesiologist Assistant
2	2471C3402X	Radiography Radiologic Technologist
3	247200000X	Other Technician
4	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1386754232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE RADIOLOGICAL SERVICES, INC

Provider Business Mailing Address
First Line	:	P.O. BOX 8000
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91327-8000
Country	:	US
Telephone Number	:	818-366-0474
Fax Number	:	818-474-7530

Provider Business Practice Location Address
First Line	:	11177 TAMPA AVE.
Second Line	:	SUITE B
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-366-0474
Fax Number	:	818-474-7530

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANJIV K. JAIN
Credential	:	M.D.
Telephone Number	:	818-366-0474

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/30/2012

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Directions to “MOBILE RADIOLOGICAL SERVICES, INC ” Practice Location

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