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General NPI Number Information
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NPI Number | 1124342431
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Entity Type | Organization
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Legal Business Name | SMI IMAGING CENTER OF SAN DIEGO, LLC
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3939 RUFFIN RD SUITE 102
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City | SAN DIEGO
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State | CA
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Zip | 92123-1815
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Country | US
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Telephone | 858-810-0375
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Fax | 858-633-0376
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Provider Business Mailing Address
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Address Line | 3939 RUFFIN RD SUITE 102
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City | SAN DIEGO
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State | CA
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Zip | 92123-1815
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Country | US
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Telephone | 858-810-0375
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Fax | 858-633-0376
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IAN M PURCELL
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Credential | M.D., PHD
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Telephone | 858-810-0373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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