Provider Demographics
NPI:1124775093
Name:PROFESSIONAL MOBILE IMAGING
Entity type:Organization
Organization Name:PROFESSIONAL MOBILE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LABUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-327-6679
Mailing Address - Street 1:3112 DONA CLARA PL
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4308
Mailing Address - Country:US
Mailing Address - Phone:323-327-6679
Mailing Address - Fax:
Practice Address - Street 1:72670 FRED WARING DR STE C-203
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-5011
Practice Address - Country:US
Practice Address - Phone:323-653-6111
Practice Address - Fax:323-653-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile