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General NPI Number Information
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NPI Number | 1154580348
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Entity Type | Organization
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Legal Business Name | TRI-CITY PETCT LLC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 902 SYCAMORE AVE
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City | VISTA
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State | CA
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Zip | 92081
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Country | US
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Telephone | 714-688-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 W SUNRISE BLVD
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City | PLANTATION
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State | FL
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Zip | 33322-5406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR VICE PRESIDENT
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Name | LAURA KASSA
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Credential |
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Telephone | 904-300-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | CA
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