Provider Demographics
NPI:1649886276
Name:MOGAVERO, MARLENE (RDMS, RVT)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:MOGAVERO
Suffix:
Gender:F
Credentials:RDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23835 DEL MONTE DR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3372
Mailing Address - Country:US
Mailing Address - Phone:818-621-3954
Mailing Address - Fax:
Practice Address - Street 1:23548 LYONS AVE STE B
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5782
Practice Address - Country:US
Practice Address - Phone:661-254-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1183882471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography