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General NPI Number Information
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NPI Number | 1801036751
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Entity Type | Organization
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Legal Business Name | LIFESCAPE IMAGING CYPRESS LLC
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 24584 HAWTHORNE BLVD
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City | TORRANCE
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State | CA
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Zip | 90505-6807
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Country | US
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Telephone | 310-783-7656
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Fax |
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Provider Business Mailing Address
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Address Line | 10601 WALKER ST
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City | CYPRESS
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State | CA
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Zip | 90630-4733
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Country | US
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Telephone | 714-656-2130
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN D ROTONDO
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Credential |
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Telephone | 310-265-3123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G065833
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A29726
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License Number State | CA
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