Healthcare Provider Details

I. General information

NPI: 1588733281
Provider Name (Legal Business Name): SHARP AND CHILDREN'S MRI CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 FROST ST
SAN DIEGO CA
92123-2701
US

IV. Provider business mailing address

PO BOX 23326
SAN DIEGO CA
92193-3326
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-4550
  • Fax: 858-939-4596
Mailing address:
  • Phone: 858-565-0950
  • Fax: 858-244-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberB1988009338
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberB1988009338
License Number StateCA

VIII. Authorized Official

Name: RUSSELL N. LOW
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 858-565-0950