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General NPI Number Information
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NPI Number | 1083662522
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Entity Type | Organization
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Legal Business Name | MOLECULAR IMAGING CORPORATION
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 9530 TOWNE CENTRE DR SUITE 120
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City | SAN DIEGO
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State | CA
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Zip | 92121-1981
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Country | US
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Telephone | 858-642-0032
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Fax | 858-642-0052
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Provider Business Mailing Address
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Address Line | 9530 TOWNE CENTRE DR SUITE 120
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City | SAN DIEGO
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State | CA
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Zip | 92121-1981
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Country | US
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Telephone | 858-642-0032
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Fax | 858-642-0052
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Authorized Official
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Title or Position | CEO
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Name | MR. KENNETH C FREDERICK
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Credential |
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Telephone | 858-642-0032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | B19999013291
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License Number State | CA
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