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NPI Code Detail

MEDICARE: MOLECULAR IMAGING CORPORATION

MEDICARE: MOLECULAR IMAGING CORPORATION
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
1261Q00000XClinic/Center481952CA

General Provider Information

NPI Number : 1295783652
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOLECULAR IMAGING CORPORATION
Provider Business Mailing Address
First Line : 9530 TOWNE CENTRE DR
Second Line : SUITE 120
City : SAN DIEGO
State : CA
Zip : 92121-1981
Country : US
Telephone Number : 858-642-0032
Fax Number : 858-642-0052
Provider Business Practice Location Address
First Line : 350 TERRACINA BLVD
Second Line :
City : REDLANDS
State : CA
Zip : 92373-4850
Country : US
Telephone Number : 909-335-5500
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. KENNETH C FREDERICK
Credential :
Telephone Number : 858-642-0032
Provider Enumeration Date : 05/05/2006
Last Update Date : 09/06/2023

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Directions to “MOLECULAR IMAGING CORPORATION ” Practice Location

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