Provider Demographics
NPI:1871704478
Name:MOURAD, JAIME J (RDCS, RVT)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:J
Last Name:MOURAD
Suffix:
Gender:M
Credentials:RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5926 ALESSANDRO AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1941
Mailing Address - Country:US
Mailing Address - Phone:323-806-8414
Mailing Address - Fax:
Practice Address - Street 1:5926 ALESSANDRO AVE APT 9
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1941
Practice Address - Country:US
Practice Address - Phone:323-806-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
26552246X00000X, 246XC2903X, 246XS1301X, 2471S1302X, 2471V0105X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
Not Answered246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
Not Answered246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other