R. Brent Mobile X-Ray

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

License

052421 Issued in CA

Legal business name

R. BRENT MOBILE X-RAY

Practice address

13429 Hawthorne Blvd
Hawthorne, CA 90250-5803

Phone

(310) 978-8006

Fax

(310) 970-9140

NPI assigned

Jan 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rusty Besa Balderian

Title

President

Phone

(310) 978-8006

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295889343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13429 HAWTHORNE BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505803",
            "telephone_number": "310-978-8006",
            "fax_number": "310-970-9140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13429 HAWTHORNE BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505803",
            "telephone_number": "310-978-8006",
            "fax_number": "310-970-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. BRENT MOBILE X-RAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALDERIAN",
        "authorized_official_first_name": "RUSTY",
        "authorized_official_middle_name": "BESA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-978-8006"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "CA",
            "license": "052421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.