Healthcare Provider Details

I. General information

NPI: 1588695217
Provider Name (Legal Business Name): SAN DIEGO IMAGING - CHULA VISTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 KUHN DR STE 100 SAN DIEGO IMAGING - EASTLAKE
CHULA VISTA CA
91914-4517
US

IV. Provider business mailing address

P.O. BOX 939054
SAN DIEGO CA
92193-9054
US

V. Phone/Fax

Practice location:
  • Phone: 619-397-6577
  • Fax: 619-397-5182
Mailing address:
  • Phone: 858-565-0950
  • Fax: 858-244-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number044140-06
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number044140-06
License Number StateCA

VIII. Authorized Official

Name: RICHARD W PADELFORD
Title or Position: DIRECTOR
Credential:
Phone: 858-565-0950