Provider Demographics
NPI:1497151757
Name:STOCKTON MRI & MOLECULAR IMAGING MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:STOCKTON MRI & MOLECULAR IMAGING MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMSHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-2000
Mailing Address - Street 1:PO BOX 26570
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6570
Mailing Address - Country:US
Mailing Address - Phone:209-466-2000
Mailing Address - Fax:
Practice Address - Street 1:200 E 66TH ST
Practice Address - Street 2:APT C-904
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-9175
Practice Address - Country:US
Practice Address - Phone:212-759-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty