Provider Demographics
NPI:1538487210
Name:IMAGE RX, INC.
Entity Type:Organization
Organization Name:IMAGE RX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RASCOE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-961-3668
Mailing Address - Street 1:6214 E PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4867
Mailing Address - Country:US
Mailing Address - Phone:562-961-3668
Mailing Address - Fax:562-961-3669
Practice Address - Street 1:6214 E PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4867
Practice Address - Country:US
Practice Address - Phone:562-961-3668
Practice Address - Fax:562-961-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP36074261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty