Provider Demographics
NPI:1275763120
Name:DIAMOND MOBILE ULTRASOUND
Entity Type:Organization
Organization Name:DIAMOND MOBILE ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ULTRASOUND TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GUAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-932-6869
Mailing Address - Street 1:201 JORALEMON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2678
Mailing Address - Country:US
Mailing Address - Phone:973-932-6869
Mailing Address - Fax:
Practice Address - Street 1:201 JORALEMON ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2678
Practice Address - Country:US
Practice Address - Phone:973-932-6869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty