Healthcare Provider Details

I. General information

NPI: 1508919978
Provider Name (Legal Business Name): DIS AQUISITION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 STOWE DR
POWAY CA
92064-8803
US

IV. Provider business mailing address

4519 GEORGE RD STE 100
TAMPA FL
33634-7329
US

V. Phone/Fax

Practice location:
  • Phone: 800-947-6134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MICHAEL KEENAN
Title or Position: CEO
Credential:
Phone: 813-496-1075