Provider Demographics
NPI:1003412982
Name:MAXIMAL INTENSITY PROJECTION LLC
Entity Type:Organization
Organization Name:MAXIMAL INTENSITY PROJECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERIEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:949-293-2662
Mailing Address - Street 1:38 CLEAR CRK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1272
Mailing Address - Country:US
Mailing Address - Phone:949-293-2662
Mailing Address - Fax:949-266-5589
Practice Address - Street 1:12191 FRONT ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4203
Practice Address - Country:US
Practice Address - Phone:562-920-5292
Practice Address - Fax:562-920-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile