Provider Demographics
NPI:1437641727
Name:MEDICAL IMAGING CENTER OF SOUTHERN CALIFORNIA-BEVERLY HILLS, INC
Entity Type:Organization
Organization Name:MEDICAL IMAGING CENTER OF SOUTHERN CALIFORNIA-BEVERLY HILLS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JABOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-9788
Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-829-9788
Mailing Address - Fax:310-584-9999
Practice Address - Street 1:8727 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-829-9788
Practice Address - Fax:310-584-9999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL IMAGING CENTER OF SOUTHERN CALIFOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-01
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty