Provider Demographics
NPI:1003255258
Name:CORNERSTONE MOBILE IMAGING
Entity Type:Organization
Organization Name:CORNERSTONE MOBILE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIBERIU
Authorized Official - Middle Name:ANDREI
Authorized Official - Last Name:PODOBEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-793-9256
Mailing Address - Street 1:20399 N FLETCHER WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-1422
Mailing Address - Country:US
Mailing Address - Phone:602-793-9256
Mailing Address - Fax:
Practice Address - Street 1:20399 N FLETCHER WAY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-1422
Practice Address - Country:US
Practice Address - Phone:602-793-9256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL18367038261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile