Provider Demographics
NPI:1134839848
Name:COVALENT RADIOLOGY INC A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:COVALENT RADIOLOGY INC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EMEEL
Authorized Official - Last Name:MOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-801-8878
Mailing Address - Street 1:11199 TESOTA LOOP ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-3059
Mailing Address - Country:US
Mailing Address - Phone:714-801-8878
Mailing Address - Fax:
Practice Address - Street 1:3231 WARING CT STE N
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4510
Practice Address - Country:US
Practice Address - Phone:714-801-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty