Provider Demographics
NPI:1689794224
Name:COMMUNITY IMAGING GROUP
Entity Type:Organization
Organization Name:COMMUNITY IMAGING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPA
Authorized Official - Phone:562-674-2911
Mailing Address - Street 1:13330 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3251
Mailing Address - Country:US
Mailing Address - Phone:562-674-2911
Mailing Address - Fax:562-674-2917
Practice Address - Street 1:9530 IMPERIAL HWY
Practice Address - Street 2:SUITE L
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3041
Practice Address - Country:US
Practice Address - Phone:562-803-9477
Practice Address - Fax:562-803-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06CA1109247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty