Healthcare Provider Details

I. General information

NPI: 1306942834
Provider Name (Legal Business Name): LAGUNA NIGUEL MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 RANCHO NIGUEL RD SUITE 140
LAGUNA NIGUEL CA
92677-7302
US

IV. Provider business mailing address

25500 RANCHO NIGUEL RD SUITE 140
LAGUNA NIGUEL CA
92677-7302
US

V. Phone/Fax

Practice location:
  • Phone: 949-362-3973
  • Fax: 949-362-3977
Mailing address:
  • Phone: 949-362-3973
  • Fax: 949-362-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LESLIE G. WEBER
Title or Position: COO
Credential:
Phone: 858-455-7127