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General NPI Number Information
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NPI Number | 1528219672
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Entity Type | Organization
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Legal Business Name | CELLGENIX IMAGING SERVICES OF PHOENIX LLC
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 4540 E COTTON GIN LOOP
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City | PHOENIX
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State | AZ
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Zip | 85040-8887
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Country | US
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Telephone | 949-276-7155
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Fax | 949-276-7158
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Provider Business Mailing Address
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Address Line | 29222 RANCHO VIEJO RD SUITE 101
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1041
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Country | US
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Telephone | 949-276-7155
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Fax | 949-276-7158
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Authorized Official
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Title or Position | CEO
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Name | MR. JIM CORLLETT
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Credential | MBR
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Telephone | 949-276-7155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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