Provider Demographics
NPI:1578566808
Name:GCC IMAGING, LLC
Entity Type:Organization
Organization Name:GCC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-412-8181
Mailing Address - Street 1:633 AERICK ST
Mailing Address - Street 2:# 105
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1978
Mailing Address - Country:US
Mailing Address - Phone:310-412-8181
Mailing Address - Fax:310-412-9299
Practice Address - Street 1:633 AERICK ST
Practice Address - Street 2:# 105
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1978
Practice Address - Country:US
Practice Address - Phone:310-412-8181
Practice Address - Fax:310-412-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7280-192471N0900X, 2471V0105X
CACLF336330291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG407Medicare ID - Type Unspecified
CAAT938Medicare PIN