Healthcare Provider Details

I. General information

NPI: 1952335135
Provider Name (Legal Business Name): OLSON IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N STEPHANIE ST STE 423
HENDERSON NV
89014-2633
US

IV. Provider business mailing address

2424 N GRAND AVE STE A1
SANTA ANA CA
92705
US

V. Phone/Fax

Practice location:
  • Phone: 702-340-7111
  • Fax: 714-479-0463
Mailing address:
  • Phone: 714-479-0461
  • Fax: 714-479-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL MCINTRYE
Title or Position: OWNER PRESIDENT
Credential:
Phone: 714-479-0461