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General NPI Number Information
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NPI Number | 1356620512
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Entity Type | Organization
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Legal Business Name | JACARANDA RADIOLOGY
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 12021 JACARANDA AVE STE 104
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City | HESPERIA
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State | CA
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Zip | 92345-4978
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Country | US
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Telephone | 760-956-5561
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Fax |
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Provider Business Mailing Address
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Address Line | 12021 JACARANDA AVE STE 104
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City | HESPERIA
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State | CA
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Zip | 92345-4978
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Country | US
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Telephone | 760-956-5561
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | MISS LAKESHA SCOTT
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Credential | VN
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Telephone | 760-956-2636
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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 |
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