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General NPI Number Information
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NPI Number | 1821313370
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Entity Type | Organization
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Legal Business Name | MEMORIALCARE IMAGING CENTER AT SAN CLEMENTE, LLC
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Dates
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Enumeration Date | 03/27/2010
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 675 CAMINO DE LOS MARES SUITE 101
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City | SAN CLEMENTE
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State | CA
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Zip | 92673
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Country | US
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Telephone | 949-493-8799
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Fax | 949-493-2625
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Provider Business Mailing Address
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Address Line | 675 CAMINO DE LOS MARES SUITE 101
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2835
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Country | US
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Telephone | 949-493-8799
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Fax | 949-493-2625
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | CHRIS FINCH
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Credential |
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Telephone | 714-377-3218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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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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