Provider Demographics
NPI:1609348036
Name:GOOD SHEPHERD HEALTHCARE LLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD HEALTHCARE LLC
Other - Org Name:MEDICAL IMAGING AND INTERVENTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EMEEL
Authorized Official - Last Name:MOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-801-8878
Mailing Address - Street 1:11199 TESOTA LOOP ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-3059
Mailing Address - Country:US
Mailing Address - Phone:714-801-8878
Mailing Address - Fax:
Practice Address - Street 1:9395 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3747
Practice Address - Country:US
Practice Address - Phone:714-801-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Multi-Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Multi-Specialty