Healthcare Provider Details

I. General information

NPI: 1952476780
Provider Name (Legal Business Name): AURORA BREAST MRI OF ORANGE COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR BLDG 20
ORANGE CA
92868
US

IV. Provider business mailing address

39 HIGH STREET
NORTH ANDOVER MA
01845
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8198
  • Fax: 714-456-8199
Mailing address:
  • Phone: 978-975-1283
  • Fax: 978-975-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number200631510025
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN JAMES
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 978-975-7530