Healthcare Provider Details

I. General information

NPI: 1962754077
Provider Name (Legal Business Name): NORTH COUNTY RADIOLOGY OCEANSIDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 WARING RD SUITE C
OCEANSIDE CA
92056-4455
US

IV. Provider business mailing address

3909 WARING RD STE C
OCEANSIDE CA
92056-4455
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-0014
  • Fax: 760-630-0015
Mailing address:
  • Phone: 760-630-0014
  • Fax: 760-630-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONALD J. PONEC
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 760-940-4055