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General NPI Number Information
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NPI Number | 1376055152
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Entity Type | Organization
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Legal Business Name | PLAZA MEDICAL IMAGING
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 3731 S PLAZA DR
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City | SANTA ANA
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State | CA
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Zip | 92704-7463
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Country | US
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Telephone | 714-918-0478
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Fax | 714-918-0470
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Provider Business Mailing Address
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Address Line | 3731 S PLAZA DR
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City | SANTA ANA
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State | CA
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Zip | 92704-7463
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Country | US
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Telephone | 714-918-0478
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Fax | 714-918-0470
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. PAUL MARK WOOTTON
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Credential |
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Telephone | 714-918-0478
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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 | FAC00063463
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License Number State | CA
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