Healthcare Provider Details

I. General information

NPI: 1689635971
Provider Name (Legal Business Name): FULLY OPEN MRI OF RANCHO BERNARDO LLC DBA POMERADO IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD SUITE 109
POWAY CA
92064-2068
US

IV. Provider business mailing address

PO BOX 460875
ESCONDIDO CA
92046-0875
US

V. Phone/Fax

Practice location:
  • Phone: 858-485-6094
  • Fax: 858-485-6059
Mailing address:
  • Phone: 760-520-8500
  • Fax: 760-520-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number3184
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number3184
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW D POLANSKY
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 760-520-8500