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Organization
SAN BERNARDINO IMAGING LLC
Active
Organization
SAN BERNARDINO IMAGING LLC
Active
Other names
Computerized Diagnostic Imaging Centers - San Bernardino
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
1884 BUSINESS CENTER DR, SAN BERNARDINO, CA 92408-3457
(909) 890-4090
(909) 890-4051
Mailing address
1884 BUSINESS CENTER DR, SAN BERNARDINO, CA 92408-3457
(909) 890-4090
(909) 890-4051
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTF00700
—
CA
01
—
P00385820
RR MEDICARE
CA
Enumeration date
08/09/2005
Last updated
03/18/2008
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