MEDICARE: PACIFIC COAST ULTRASOUND, 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

General Provider Information

NPI Number	:	1841203247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC COAST ULTRASOUND, INC.

Provider Business Mailing Address
First Line	:	4622 KATELLA AVE
Second Line	:	SUITE 101
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2677
Country	:	US
Telephone Number	:	562-596-3428
Fax Number	:	562-596-3438

Provider Business Practice Location Address
First Line	:	4622 KATELLA AVE
Second Line	:	SUITE 101
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2677
Country	:	US
Telephone Number	:	562-596-3428
Fax Number	:	562-596-3438

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DARLENE GINNETT
Credential	:
Telephone Number	:	562-596-3428

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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Directions to “PACIFIC COAST ULTRASOUND, INC. ” Practice Location

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