Organization
MAMMO Q PLUS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. YOLANDA TARROZA VIDA (PRESIDENT)
(310) 518-2620
Entity
Organization
Contact information
Practice address
22020 AVALON BLVD, CARSON, CA 90745-3307
(310) 518-2620
(310) 835-5799
Mailing address
22020 S AVALON BLVD, CARSON, CA 90745-2734
(310) 518-2620
(310) 835-5799
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XR010016F
—
CA
Enumeration date
11/29/2006
Last updated
08/22/2020
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