Provider Demographics
NPI:1922585116
Name:S S B MOBILE DIAGNOSTIC IMAGING GROUP LLC
Entity Type:Organization
Organization Name:S S B MOBILE DIAGNOSTIC IMAGING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-777-2986
Mailing Address - Street 1:619 S MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-4003
Mailing Address - Country:US
Mailing Address - Phone:754-777-2986
Mailing Address - Fax:808-278-6011
Practice Address - Street 1:1314 S KING ST STE 723
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-278-6010
Practice Address - Fax:808-278-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological Laboratory