Provider Demographics
NPI:1780634550
Name:SONIC IMAGING
Entity Type:Organization
Organization Name:SONIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-736-2999
Mailing Address - Street 1:6230 MCLEOD DRIVE
Mailing Address - Street 2:STE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4049
Mailing Address - Country:US
Mailing Address - Phone:702-736-2999
Mailing Address - Fax:702-736-2199
Practice Address - Street 1:6230 MCLEOD DRIVE
Practice Address - Street 2:STE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4049
Practice Address - Country:US
Practice Address - Phone:702-736-2999
Practice Address - Fax:702-736-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2702019Medicaid
NV2702019Medicaid