Provider Demographics
NPI:1841616125
Name:PEEK A BOO 3D 4D MOBILE ULTRASOUND
Entity type:Organization
Organization Name:PEEK A BOO 3D 4D MOBILE ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-241-4506
Mailing Address - Street 1:14845 MONARCH BLVD
Mailing Address - Street 2:B
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-6023
Mailing Address - Country:US
Mailing Address - Phone:760-241-4506
Mailing Address - Fax:
Practice Address - Street 1:14845 MONARCH BLVD
Practice Address - Street 2:B
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-6023
Practice Address - Country:US
Practice Address - Phone:760-241-4506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUELIN IMAGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302R00000X
CA13-00722302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization