Individual
VISAL NIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.T.(R)(CT) (ARRT)
Contact information
Practice address
5901 E 7TH ST, LONG BEACH, CA 90822-5201
(562) 826-8000
Mailing address
1694 E 56TH ST, LONG BEACH, CA 90805-4802
(562) 276-3055
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
454001
MN
2471C3401X
Computed Tomography Radiologic Technologist
Primary
454001
MN
Other
Enumeration date
08/26/2013
Last updated
08/26/2013
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