MEDICARE: MOBILE CARDIAC IMAGING

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

General Provider Information

NPI Number	:	1689745358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE CARDIAC IMAGING

Provider Business Mailing Address
First Line	:	352 S CLARK DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3608
Country	:	US
Telephone Number	:	310-657-4938
Fax Number	:	310-657-0421

Provider Business Practice Location Address
First Line	:	352 S CLARK DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3608
Country	:	US
Telephone Number	:	310-657-4938
Fax Number	:	818-657-0421

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GABRIEL HERTZBERG
Credential	:
Telephone Number	:	310-657-4938

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	01/30/2015

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Directions to “MOBILE CARDIAC IMAGING ” Practice Location

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