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General NPI Number Information
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NPI Number | 1619407111
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Entity Type | Organization
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Legal Business Name | SUNNYVALE IMAGING CENTER A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 568 S MATHILDA AVE
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City | SUNNYVALE
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State | CA
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Zip | 94086-7607
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Country | US
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Telephone | 408-738-0232
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Fax | 408-738-0242
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Provider Business Mailing Address
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Address Line | 568 S MATHILDA AVE
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City | SUNNYVALE
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State | CA
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Zip | 94086-7607
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Country | US
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Telephone | 408-738-0232
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Fax | 408-738-0242
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | TERESA PEREZ
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Credential |
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Telephone | 209-261-7905
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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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