Provider Demographics
NPI:1144858184
Name:SAINT MARY SONOGRAM PC
Entity type:Organization
Organization Name:SAINT MARY SONOGRAM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:ABED NAGIUB
Authorized Official - Last Name:MARKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL SONOGRAPHER
Authorized Official - Phone:714-394-1741
Mailing Address - Street 1:83316 BEAVER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2830
Mailing Address - Country:US
Mailing Address - Phone:714-394-1741
Mailing Address - Fax:442-300-2233
Practice Address - Street 1:83316 BEAVER CREEK CT
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-2830
Practice Address - Country:US
Practice Address - Phone:714-394-1741
Practice Address - Fax:442-300-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile