Provider Demographics
NPI:1467161786
Name:MODERN MOBILE RADIOLOGY INC
Entity Type:Organization
Organization Name:MODERN MOBILE RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASATUR
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-717-7866
Mailing Address - Street 1:9350 PETIT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2726
Mailing Address - Country:US
Mailing Address - Phone:800-717-7866
Mailing Address - Fax:
Practice Address - Street 1:9350 PETIT AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91343-2726
Practice Address - Country:US
Practice Address - Phone:800-717-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier