Provider Demographics
NPI:1639102080
Name:MOBILE RADIOLOGICAL SERVICES, INC
Entity Type:Organization
Organization Name:MOBILE RADIOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-366-4512
Mailing Address - Street 1:11145 TAMPA AVE
Mailing Address - Street 2:SUITE#14A
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2255
Mailing Address - Country:US
Mailing Address - Phone:818-366-4512
Mailing Address - Fax:818-360-6319
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:SUITE #604
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1644
Practice Address - Country:US
Practice Address - Phone:818-366-4512
Practice Address - Fax:818-360-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHS72368335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier