Organization
SOUK LUANGSRINHOTHA MODESTO MOBILE IMAGING SERVICES
Active
Other names
MODESTO MOBILE IMAGING SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
SOUK LUANGSRINHOTHA R.T(R)(CT)(ARRT) (OWNER)
(209) 855-6900
Entity
Organization
Contact information
Practice address
5021 ROSSO CT, SALIDA, CA 95368-9066
(209) 855-6900
Mailing address
PO BOX 3091, MODESTO, CA 95353-3091
(209) 575-4575
(209) 575-4598
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972090652
—
CA
Enumeration date
09/13/2019
Last updated
09/13/2019
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