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General NPI Number Information
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NPI Number | 1821178856
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Entity Type | Organization
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Legal Business Name | ELITE DIAGNOSTIC IMAGING, LLC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 17260 BEAR VALLEY RD SUITE 109
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City | VICTORVILLE
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State | CA
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Zip | 92395-7777
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Country | US
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Telephone | 760-843-2900
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Fax | 760-843-0144
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Provider Business Mailing Address
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Address Line | 17260 BEAR VALLEY RD SIUTE 112
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City | VICTORVILLE
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State | CA
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Zip | 92395-7777
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Country | US
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Telephone | 760-843-2900
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Fax | 760-843-0144
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Authorized Official
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Title or Position | COO
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Name | HECTOR A. TORRES
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Credential |
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Telephone | 760-843-2900
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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 | 200432110020
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License Number State | CA
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Taxonomy #2
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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 |
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