Healthcare Provider Details

I. General information

NPI: 1376690636
Provider Name (Legal Business Name): COAST RADIOLOGY IMAGING AND INTERVENTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 MEDICAL CENTER ROAD RADIOLOGY DEPARTMENT
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

DEPT LA 21789
PASADENA CA
91185-1789
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-7744
  • Fax: 949-364-4233
Mailing address:
  • Phone: 949-263-8620
  • Fax: 949-263-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD LEMPERT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-364-7744