Healthcare Provider Details

I. General information

NPI: 1518902329
Provider Name (Legal Business Name): LOS ALAMITOS IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 KATELLA AVE SUITE 101
LOS ALAMITOS CA
90720-3108
US

IV. Provider business mailing address

8300 W SUNRISE BLVD
PLANTATION FL
33322-5406
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-3276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONI COOPER
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 754-206-6198