Healthcare Provider Details

I. General information

NPI: 1205898095
Provider Name (Legal Business Name): ANAHEIM HILLS MEDICAL IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS RD #136
ANAHEIM HILLS CA
92807-4780
US

IV. Provider business mailing address

500 S ANAHEIM HILLS RD #136
ANAHEIM HILLS CA
92807-4780
US

V. Phone/Fax

Practice location:
  • Phone: 714-282-8160
  • Fax: 714-282-7031
Mailing address:
  • Phone: 714-282-8160
  • Fax: 714-282-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LISA BROCKETT
Title or Position: CEO
Credential:
Phone: 949-250-4500