Provider Demographics
NPI:1750670584
Name:MAF IMAGING CENTER LLC
Entity Type:Organization
Organization Name:MAF IMAGING CENTER LLC
Other - Org Name:SANBERNARDINO OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOOSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIKALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-481-0858
Mailing Address - Street 1:PO BOX 49911
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-0911
Mailing Address - Country:US
Mailing Address - Phone:310-481-0858
Mailing Address - Fax:310-474-3416
Practice Address - Street 1:1884 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3457
Practice Address - Country:US
Practice Address - Phone:909-890-5552
Practice Address - Fax:909-890-5588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAF IMAGING CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile