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General NPI Number Information
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NPI Number | 1891747200
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Entity Type | Organization
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Legal Business Name | DIGITAL & RADIOLOGIC IMAGING ASSOCIATES INC. A MEDICAL GROUP
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 17100 EUCLID ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4004
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Country | US
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Telephone | 714-966-8041
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3148
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City | MISSION VIEJO
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State | CA
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Zip | 92690-1148
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Country | US
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Telephone | 949-348-1105
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Fax | 949-348-1210
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLIOTT J. WAGNER
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Credential | M.D.
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Telephone | 949-348-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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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 | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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