Organization
SECOND AVENUE MRI LLC
Active
Other names
Advanced MRI
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD MARTINEZ M.D. (PRESIDENT)
(337) 494-2674
Entity
Organization
Contact information
Practice address
2770 3RD AVE, SUITE 125, LAKE CHARLES, LA 70601-8994
(337) 494-2674
(337) 494-2694
Mailing address
2770 3RD AVE, SUITE 125, LAKE CHARLES, LA 70601-8994
(337) 494-2674
(337) 494-2694
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1448001
—
LA
Enumeration date
09/16/2006
Last updated
02/13/2014
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