Organization
SOUTHWEST MOBILE DIAGNOSTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARCELO LAPURGA SANTIAGO JR. SONAGRAPHER (OWNER)
(276) 322-4520
Entity
Organization
Contact information
Practice address
RR2 RIVERBEND, EST NO 26, BLUEFIELD, VA 24605-0026
(276) 322-4520
(276) 322-4520
Mailing address
PO BOX 797, NORTH TAZEWELL, VA 24630-0797
(276) 322-4520
(276) 322-4520
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0036569000
—
WV
05
—
004990200
—
VA
Enumeration date
11/24/2006
Last updated
07/10/2008
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