Healthcare Provider Details

I. General information

NPI: 1326351602
Provider Name (Legal Business Name): SAN DIEGO IMAGING - CHULA VISTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
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: 619-397-6577
  • Fax: 619-397-5182
Mailing address:
  • Phone: 858-565-0950
  • Fax: 858-565-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number044140-10
License Number StateCA

VIII. Authorized Official

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