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General NPI Number Information
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NPI Number | 1881762979
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Entity Type | Organization
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Legal Business Name | IMAGING CENTERS DIRECT LLC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 1125 E 17TH STREET STE W125
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City | SANTA ANA
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State | CA
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Zip | 92701
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Country | US
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Telephone | 714-547-3200
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Fax | 714-547-7249
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Provider Business Mailing Address
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Address Line | 1125 E 17TH STREET STE W125
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City | SANTA ANA
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State | CA
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Zip | 92701
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Country | US
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Telephone | 714-547-3200
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Fax | 714-547-7249
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Authorized Official
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Title or Position | PART OWNER
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Name | MRS. BRENDA BRENES
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Credential |
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Telephone | 714-547-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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