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General NPI Number Information
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NPI Number | 1053994848
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Entity Type | Organization
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Legal Business Name | ONBEACH RADIOLOGY ASSOCIATES
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 12602 AMARGOSA RD STE F
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City | VICTORVILLE
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State | CA
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Zip | 92392-7640
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Country | US
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Telephone | 760-261-5000
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Fax | 760-243-1123
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Provider Business Mailing Address
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Address Line | 505 N TUSTIN AVE STE 158
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City | SANTA ANA
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State | CA
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Zip | 92705-3735
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Country | US
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Telephone | 714-834-1040
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Fax | 714-834-1429
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KANISE CARRAWAY
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Credential |
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Telephone | 559-240-5697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0205X
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Taxonomy Name | Radiological Physics Physician
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License Number |
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License Number State |
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