MEDICARE: SMI IMAGING CENTER OF SAN DIEGO, LLC

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	174400000X	Specialist		CA

General Provider Information

NPI Number	:	1124342431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMI IMAGING CENTER OF SAN DIEGO, LLC

Provider Business Mailing Address
First Line	:	3939 RUFFIN RD
Second Line	:	SUITE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1815
Country	:	US
Telephone Number	:	858-810-0375
Fax Number	:	858-633-0376

Provider Business Practice Location Address
First Line	:	3939 RUFFIN RD
Second Line	:	SUITE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1815
Country	:	US
Telephone Number	:	858-810-0375
Fax Number	:	858-633-0376

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IAN M PURCELL
Credential	:	M.D., PHD
Telephone Number	:	858-810-0373

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	07/21/2022

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