Healthcare Provider Details

I. General information

NPI: 1417723024
Provider Name (Legal Business Name): NORTH COUNTY RADIOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 CITRACADO PKWY STE 100
ESCONDIDO CA
92029-4111
US

IV. Provider business mailing address

1955 CITRACADO PKWY STE 100
ESCONDIDO CA
92029-4111
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-4055
  • Fax: 858-746-5184
Mailing address:
  • Phone: 760-940-4055
  • Fax: 858-746-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD J. PONEC
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-940-4055