Provider Demographics
NPI:1386971646
Name:MONTCLAIR ULTRASOUND HEALTH CENTER, INC.
Entity type:Organization
Organization Name:MONTCLAIR ULTRASOUND HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:800-838-0384
Mailing Address - Street 1:5206 BENITO ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2852
Mailing Address - Country:US
Mailing Address - Phone:909-509-5919
Mailing Address - Fax:909-992-3182
Practice Address - Street 1:5206 BENITO ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2852
Practice Address - Country:US
Practice Address - Phone:909-509-5919
Practice Address - Fax:909-992-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70349261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology