Basic Information
| Provider Information | |||||||||
| NPI: | 1750670584 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAF IMAGING CENTER LLC | ||||||||
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| OtherOrganizationName: | SANBERNARDINO OPEN MRI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 49911 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900490911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104810858 | ||||||||
| FaxNumber: | 3104743416 | ||||||||
| Practice Location | |||||||||
| Address1: | 1884 BUSINESS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098905552 | ||||||||
| FaxNumber: | 9098905588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | HEIKALI | ||||||||
| AuthorizedOfficialFirstName: | MOOSSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3104810858 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MAF IMAGING CENTER LLC | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0208X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.