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General NPI Number Information
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NPI Number | 1003187881
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Entity Type | Organization
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Legal Business Name | MAGNETIC RESONANCE IMAGING OF SAN LUIS OBISPO, INC.
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 77 CASA ST STE 102
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-5804
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Country | US
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Telephone | 805-546-7698
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Fax | 805-543-5818
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Provider Business Mailing Address
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Address Line | 77 CASA ST STE 102
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-5804
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Country | US
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Telephone | 805-546-7733
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Fax | 805-549-9217
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | JAIKUMAR KRISHNASWAMY
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Credential |
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Telephone | 972-713-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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