Provider Demographics
NPI:1639843592
Name:IEMISI
Entity Type:Organization
Organization Name:IEMISI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-479-8994
Mailing Address - Street 1:1902 FULLERTON AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3112
Mailing Address - Country:US
Mailing Address - Phone:951-479-8994
Mailing Address - Fax:619-209-7888
Practice Address - Street 1:1902 FULLERTON AVE # 1
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881
Practice Address - Country:US
Practice Address - Phone:951-479-8994
Practice Address - Fax:619-209-7888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IEMISI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty