Provider Demographics
NPI:1326356213
Name:BIODATA RADIOLOGY SERVICES INC
Entity Type:Organization
Organization Name:BIODATA RADIOLOGY SERVICES INC
Other - Org Name:STATMOBILE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-466-9939
Mailing Address - Street 1:4650 ARROW HWY STE F4
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1218
Mailing Address - Country:US
Mailing Address - Phone:909-333-4200
Mailing Address - Fax:949-281-7707
Practice Address - Street 1:4650 ARROW HWY STE F4
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1218
Practice Address - Country:US
Practice Address - Phone:909-333-4200
Practice Address - Fax:949-281-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X, 261QR0208X
CA335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Multi-Specialty