MEDICARE: INLAND EMPIRE IMAGING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1295141950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND EMPIRE IMAGING

Provider Business Mailing Address
First Line	:	18111 BROOKHURST ST
Second Line	:	SUITE 6100
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6728
Country	:	US
Telephone Number	:	714-698-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 E ONTARIO AVE
Second Line	:	SUITE 101A
City	:	CORONA
State	:	CA
Zip	:	92879-3506
Country	:	US
Telephone Number	:	951-371-2411
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	HAMESH A SHAHANI
Credential	:
Telephone Number	:	310-237-2240

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	12/04/2014

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Directions to “INLAND EMPIRE IMAGING ” Practice Location

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