Healthcare Provider Details

I. General information

NPI: 1689983926
Provider Name (Legal Business Name): ANAHEIM HILLS MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 S WEIR CANYON RD SUITE 185
ANAHEIM CA
92808-1965
US

IV. Provider business mailing address

781 S WEIR CANYON RD STE 185
ANAHEIM CA
92808-1965
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 TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN KEITH PRINCE
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 619-929-1836