Provider Demographics
NPI:1306033840
Name:ATLAS IMAGING, L.L.C.
Entity Type:Organization
Organization Name:ATLAS IMAGING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KENDRA
Authorized Official - Last Name:PRONIA-BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-900-7204
Mailing Address - Street 1:9619 BLANCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5811
Mailing Address - Country:US
Mailing Address - Phone:909-900-7204
Mailing Address - Fax:
Practice Address - Street 1:9619 BLANCHARD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5811
Practice Address - Country:US
Practice Address - Phone:909-900-7204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory