Provider Demographics
NPI:1124521331
Name:ADVANCED MFM IMAGING CENTER, INC.
Entity type:Organization
Organization Name:ADVANCED MFM IMAGING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANYELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-939-4040
Mailing Address - Street 1:1577 E CHEVY CHASE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4092
Mailing Address - Country:US
Mailing Address - Phone:818-240-8300
Mailing Address - Fax:
Practice Address - Street 1:1577 E CHEVY CHASE DR STE 300
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4092
Practice Address - Country:US
Practice Address - Phone:818-240-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA320232085U0001X, 2085R0202X
CAA69154207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty