Healthcare Provider Details

I. General information

NPI: 1063805562
Provider Name (Legal Business Name): ART OF XRAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 LOMA ALTA
SAN MARCOS CA
92069-8317
US

IV. Provider business mailing address

1531 LOMA ALTA
SAN MARCOS CA
92069-8317
US

V. Phone/Fax

Practice location:
  • Phone: 760-687-5992
  • Fax:
Mailing address:
  • Phone: 760-687-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ARTHUR JAIME
Title or Position: RADIOLOGIC TECHNOLOGIST
Credential:
Phone: 760-687-5992