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General NPI Number Information
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NPI Number | 1891982484
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Entity Type | Organization
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Legal Business Name | FULL BODY SCANNING OF ORANGE COUNTY LLC
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 3 CORPORATE PLAZA SUITE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-726-6470
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Fax | 858-272-0690
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Provider Business Mailing Address
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Address Line | 8677 VIA LA JOLLA DR #1252
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City | LA JOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 949-706-6470
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Fax | 858-272-0698
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DINO BERARDINO
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Credential |
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Telephone | 619-778-3913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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