Provider Demographics
NPI:1689992380
Name:BLUEBEAM RADIOLOGY PC
Entity Type:Organization
Organization Name:BLUEBEAM RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-245-7814
Mailing Address - Street 1:3113 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1725
Mailing Address - Country:US
Mailing Address - Phone:562-245-7814
Mailing Address - Fax:
Practice Address - Street 1:3113 CORONADO DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1725
Practice Address - Country:US
Practice Address - Phone:562-245-7814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA927122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty