Healthcare Provider Details

I. General information

NPI: 1972713311
Provider Name (Legal Business Name): PACIFIC COAST MRI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2756 E FLORENCE AVE
HUNTINGTON PARK CA
90255-5747
US

IV. Provider business mailing address

1638 E 17TH ST SUITE I
SANTA ANA CA
92705-8515
US

V. Phone/Fax

Practice location:
  • Phone: 323-587-3236
  • Fax: 323-587-3236
Mailing address:
  • Phone: 714-836-4545
  • Fax: 714-836-4588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EMMANUAL GO
Title or Position: PRESIDENT
Credential:
Phone: 714-836-4545