Provider Demographics
NPI:1225787724
Name:LOS FRESNOS IMAGE CENTER LLC
Entity Type:Organization
Organization Name:LOS FRESNOS IMAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONOGRAPHER , ULTRASOUND
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-561-1284
Mailing Address - Street 1:32819 STATE HIGHWAY 100 STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4448
Mailing Address - Country:US
Mailing Address - Phone:956-561-1284
Mailing Address - Fax:956-435-0238
Practice Address - Street 1:32819 STATE HIGHWAY 100 STE 107
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4448
Practice Address - Country:US
Practice Address - Phone:956-561-1284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile