MEDICARE: MOBILE MAMMOGRAPHY SCREENING 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	261QR0207X	Mobile Mammography Clinic/Center	223386	CA

General Provider Information

NPI Number	:	1457654279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE MAMMOGRAPHY SCREENING INC

Provider Business Mailing Address
First Line	:	15335 MORRISON ST
Second Line	:	SUITE 304
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1513
Country	:	US
Telephone Number	:	818-528-6466
Fax Number	:	818-528-3464

Provider Business Practice Location Address
First Line	:	15335 MORRISON ST
Second Line	:	SUITE 304
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1513
Country	:	US
Telephone Number	:	818-528-6466
Fax Number	:	818-528-3464

Authorized Official
Title or Position	:	PARTNER
Name	:	LAWRENCE H RESNICK
Credential	:	M.D.
Telephone Number	:	310-829-2931

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	12/30/2014

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