Provider Demographics
NPI:1659561926
Name:MOBILE EXPRESS ULTRASOUND IMAGING, INC
Entity Type:Organization
Organization Name:MOBILE EXPRESS ULTRASOUND IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKUR
Authorized Official - Suffix:
Authorized Official - Credentials:RVT, RDMS
Authorized Official - Phone:213-448-6661
Mailing Address - Street 1:531 N ROSSMORE AVE
Mailing Address - Street 2:202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-2453
Mailing Address - Country:US
Mailing Address - Phone:213-448-6661
Mailing Address - Fax:323-466-7255
Practice Address - Street 1:531 N ROSSMORE AVE
Practice Address - Street 2:202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-2453
Practice Address - Country:US
Practice Address - Phone:213-448-6661
Practice Address - Fax:323-466-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
81173246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty