Provider Demographics
NPI:1508583188
Name:GENTRY IMAGING INC
Entity Type:Organization
Organization Name:GENTRY IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/AM
Authorized Official - Prefix:
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-487-9992
Mailing Address - Street 1:PO BOX 1537
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-5537
Mailing Address - Country:US
Mailing Address - Phone:626-487-9992
Mailing Address - Fax:
Practice Address - Street 1:333 E RAINBOW DR
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2134
Practice Address - Country:US
Practice Address - Phone:626-487-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier