MEDICARE: FALLBROOK IMAGING CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center
2	2085B0100X	Body Imaging Physician

General Provider Information

NPI Number	:	1083220842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLBROOK IMAGING CENTER INC

Provider Business Mailing Address
First Line	:	616 E ALVARADO ST STE E
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-2350
Country	:	US
Telephone Number	:	760-689-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 E ALVARADO ST STE D
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-2350
Country	:	US
Telephone Number	:	760-689-6100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANKE CILING
Credential	:
Telephone Number	:	760-689-6100

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	11/18/2020

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Directions to “FALLBROOK IMAGING CENTER INC ” Practice Location

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