Provider Demographics
NPI:1619600673
Name:PRO IMAGINING AZ LLC
Entity Type:Organization
Organization Name:PRO IMAGINING AZ LLC
Other - Org Name:PRO IMAGINING AZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRIANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-224-0064
Mailing Address - Street 1:967 HANCOCK RD STE 133
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5142
Mailing Address - Country:US
Mailing Address - Phone:928-224-0064
Mailing Address - Fax:480-842-8608
Practice Address - Street 1:1225 HANCOCK RD # 50
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5948
Practice Address - Country:US
Practice Address - Phone:928-224-0064
Practice Address - Fax:480-842-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty