=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417763830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2024
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1031 W CHAPMAN AVE STE 101
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-2872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-763-5502
-----------------------------------------------------
Fax | 714-763-5502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1031 W CHAPMAN AVE STE 101
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-2872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-763-5502
-----------------------------------------------------
Fax | 714-763-5502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JARED SCHULTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-763-5502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------