Provider Demographics
NPI:1023075298
Name:OPEN MRI INC
Entity type:Organization
Organization Name:OPEN MRI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR V.P. & CHIEF ACCOUNTING OFCR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRAZBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-6000
Mailing Address - Street 1:FILE 57174
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:949-282-6000
Mailing Address - Fax:
Practice Address - Street 1:3521 INVESTMENT BLVD
Practice Address - Street 2:STE 5
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-3704
Practice Address - Country:US
Practice Address - Phone:510-670-0700
Practice Address - Fax:510-784-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70096FMedicaid
CAZZZ17273ZMedicare PIN