MEDICARE: MY IMAGING CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	2085B0100X	Body Imaging Physician	CA
2	2085R0202X	Diagnostic Radiology Physician	CA
3	2085U0001X	Diagnostic Ultrasound Physician	CA
4	247100000X	Radiologic Technologist	CA
5	2471C3401X	Computed Tomography Radiologic Technologist	CA
6	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	CA
7	305R00000X	Preferred Provider Organization	CA
8	261QR0200X	Radiology Clinic/Center	CA

General Provider Information

NPI Number	:	1356617096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY IMAGING CENTER

Provider Business Mailing Address
First Line	:	5757 WILSHIRE BLVD STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3686
Country	:	US
Telephone Number	:	323-648-0500
Fax Number	:	323-648-0508

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	:	760-689-6110

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. PERLA I NUNEZ
Credential	:
Telephone Number	:	323-648-0500

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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Directions to “MY IMAGING CENTER ” Practice Location

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