Provider Demographics
NPI:1043232994
Name:MOURAD CORPORATION
Entity Type:Organization
Organization Name:MOURAD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURAD
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS , RVT
Authorized Official - Phone:323-589-6241
Mailing Address - Street 1:2275 HUNTINGTON DR # 310
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2640
Mailing Address - Country:US
Mailing Address - Phone:323-589-6241
Mailing Address - Fax:323-589-3407
Practice Address - Street 1:8350 FLORENCE AVE
Practice Address - Street 2:#2
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3961
Practice Address - Country:US
Practice Address - Phone:323-589-6241
Practice Address - Fax:323-589-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246W00000X, 246XC2903X, 246XS1301X, 246ZE0600X, 2471M1202X
CA265522471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
Not Answered246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
Not Answered246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
Not Answered246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG217Medicare ID - Type UnspecifiedIDTF