| Organization Name: | BA IMAGING GROUP |
| NPI Number: | 1003135674 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GUSTAVO MARTINELLI (DIRECTOR) |
| Mailing Address: | 14622 Ventura Blvd Suite # 317 Sherman Oaks |
| State: | CA US |
| Postal Code: | 914033600 |
| Phone Number: | 8185549903 |
| Fax Number: | 8183458746 |
| NPI Enumeration Date: | 05/21/2010 |
| NPI Last Update Date: | 05/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 293D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Laboratories |
| Taxonomy Classification: | Physiological Laboratory |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |