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NPI Code Detail

MEDICARE: WHITTIER BREAST IMAGING PROFESSIONAL MEDICAL CORPORATION

MEDICARE: WHITTIER BREAST IMAGING PROFESSIONAL MEDICAL CORPORATION
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
12085R0202XDiagnostic Radiology Physician70407CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
170407OTHERCALICENSE

General Provider Information

NPI Number : 1841438074
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITTIER BREAST IMAGING PROFESSIONAL MEDICAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 1277
Second Line :
City : WHITTIER
State : CA
Zip : 90609-1277
Country : US
Telephone Number : 562-906-6470
Fax Number : 562-946-9465
Provider Business Practice Location Address
First Line : 12393 WASHINGTON BLVD
Second Line :
City : WHITTIER
State : CA
Zip : 90606-2502
Country : US
Telephone Number : 562-907-0667
Fax Number : 562-907-4162
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : MAUREEN C JENSEN
Credential : M.D.
Telephone Number : 562-698-0811
Provider Enumeration Date : 01/26/2009
Last Update Date : 07/13/2009

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