Healthcare Provider Details

I. General information

NPI: 1225680069
Provider Name (Legal Business Name): JOHN MUIR MAGNETIC IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD STE 7-421
HONOLULU HI
96813-4902
US

IV. Provider business mailing address

2125 OAK GROVE RD STE 200
WALNUT CREEK CA
94598-2520
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-7150
  • Fax:
Mailing address:
  • Phone: 925-296-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: IRA FINCH
Title or Position: MANAGING EMPLOYEE
Credential:
Phone: 925-296-7150