Healthcare Provider Details

I. General information

NPI: 1992892137
Provider Name (Legal Business Name): WINE COUNTRY OPEN MRI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 BROADWAY ST
AMERICAN CANYON CA
94503-1261
US

IV. Provider business mailing address

3419 BROADWAY ST
AMERICAN CANYON CA
94503-1261
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-9674
  • Fax: 707-558-9675
Mailing address:
  • Phone: 707-558-9674
  • Fax: 707-558-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ARNOLD RAMOS
Title or Position: OWNER
Credential:
Phone: 707-558-9674