Healthcare Provider Details

I. General information

NPI: 1801965058
Provider Name (Legal Business Name): SAN DIEGO IMAGING - CHULA VISTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 MEDICAL CENTER CT
CHULA VISTA CA
91911-6600
US

IV. Provider business mailing address

PO BOX 939054
SAN DIEGO CA
92193-9054
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-0950
  • Fax: 858-244-1100
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 TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number044140-06
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number044140-06
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number044140-06
License Number StateCA

VIII. Authorized Official

Name: RICK W. PADELFORD
Title or Position: BOARD OF DIRECTORS
Credential:
Phone: 858-565-0950