Provider Demographics
NPI:1255396479
Name:LOMA LINDA HIGH FIELD OPEN MRI AND DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:LOMA LINDA HIGH FIELD OPEN MRI AND DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEIMANPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-478-9192
Mailing Address - Street 1:PO BOX 26570
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6570
Mailing Address - Country:US
Mailing Address - Phone:559-455-4000
Mailing Address - Fax:559-455-4004
Practice Address - Street 1:10459 MOUNTAIN VIEW AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-478-9192
Practice Address - Fax:909-478-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66826ZOtherBLUE SHIELD
CADE6393Medicare PIN
CAZZZ03557ZMedicare PIN