Provider Demographics
NPI:1194904839
Name:ALPHA PORTABLE X-RAY INC
Entity type:Organization
Organization Name:ALPHA PORTABLE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:SOSA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RAD TECH RT
Authorized Official - Phone:702-580-1652
Mailing Address - Street 1:11990 CAMDEN BROOK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5642
Mailing Address - Country:US
Mailing Address - Phone:702-875-1007
Mailing Address - Fax:702-431-3354
Practice Address - Street 1:11990 CAMDEN BROOK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-5642
Practice Address - Country:US
Practice Address - Phone:702-875-1007
Practice Address - Fax:702-431-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN413784247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty