MEDICARE: FAIRFAX MRI CENTER

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	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	177510-86	CA

General Provider Information

NPI Number	:	1861429102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRFAX MRI CENTER

Provider Business Mailing Address
First Line	:	5757 WILSHIRE BLVD STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3686
Country	:	US
Telephone Number	:	323-648-0500
Fax Number	:	323-648-0508

Provider Business Practice Location Address
First Line	:	5757 WILSHIRE BLVD STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3686
Country	:	US
Telephone Number	:	323-648-0500
Fax Number	:	323-648-0508

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MIKE RAJAEE
Credential	:
Telephone Number	:	323-648-0500

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/22/2020

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Directions to “FAIRFAX MRI CENTER ” Practice Location

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