Healthcare Provider Details

I. General information

NPI: 1376055152
Provider Name (Legal Business Name): PLAZA MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 S PLAZA DR
SANTA ANA CA
92704-7463
US

IV. Provider business mailing address

3731 S PLAZA DR
SANTA ANA CA
92704-7463
US

V. Phone/Fax

Practice location:
  • Phone: 714-918-0478
  • Fax: 714-918-0470
Mailing address:
  • Phone: 714-918-0478
  • Fax: 714-918-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberFAC00063463
License Number StateCA

VIII. Authorized Official

Name: MR. PAUL MARK WOOTTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 714-918-0478