Provider Demographics
NPI:1386927366
Name:MOBILE DIAGNOSTIC SOLUTIONS, INC.
Entity type:Organization
Organization Name:MOBILE DIAGNOSTIC SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-603-8333
Mailing Address - Street 1:15130 VENTURA BLVD
Mailing Address - Street 2:303
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3301
Mailing Address - Country:US
Mailing Address - Phone:818-574-6390
Mailing Address - Fax:818-474-7174
Practice Address - Street 1:15130 VENTURA BLVD
Practice Address - Street 2:303
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3301
Practice Address - Country:US
Practice Address - Phone:818-574-6390
Practice Address - Fax:818-474-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology