Healthcare Provider Details

I. General information

NPI: 1093007502
Provider Name (Legal Business Name): FALLBROOK DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E ALVARADO ST STE D
FALLBROOK CA
92028-2350
US

IV. Provider business mailing address

616 E ALVARADO ST STE D
FALLBROOK CA
92028-2350
US

V. Phone/Fax

Practice location:
  • Phone: 760-689-6100
  • Fax:
Mailing address:
  • Phone: 760-689-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberA73716
License Number StateCA

VIII. Authorized Official

Name: MS. PERLA I NUNEZ
Title or Position: MANAGER
Credential:
Phone: 760-689-6100