Provider Demographics
NPI:1730643651
Name:PAHRUMP IMAGING LLC
Entity Type:Organization
Organization Name:PAHRUMP IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-408-0227
Mailing Address - Street 1:5384 SPLENDIDO AVE
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89061-0144
Mailing Address - Country:US
Mailing Address - Phone:310-408-0227
Mailing Address - Fax:
Practice Address - Street 1:1397 S LOOP RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4729
Practice Address - Country:US
Practice Address - Phone:775-771-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty