Healthcare Provider Details

I. General information

NPI: 1649483553
Provider Name (Legal Business Name): ORANGE COUNTY SPINAL IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 E ABBEY LN
ORANGE CA
92867-2009
US

IV. Provider business mailing address

3145 E ABBEY LN
ORANGE CA
92867-2009
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-7246
  • Fax:
Mailing address:
  • Phone: 949-552-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberRHC147719
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN J DONOGHUE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-538-4088