MEDICARE: LAGUNA NIGUEL MRI

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	:	1306942834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA NIGUEL MRI

Provider Business Mailing Address
First Line	:	25500 RANCHO NIGUEL RD
Second Line	:	SUITE 140
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7302
Country	:	US
Telephone Number	:	949-362-3973
Fax Number	:	949-362-3977

Provider Business Practice Location Address
First Line	:	25500 RANCHO NIGUEL RD
Second Line	:	SUITE 140
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7302
Country	:	US
Telephone Number	:	949-362-3973
Fax Number	:	949-362-3977

Authorized Official
Title or Position	:	COO
Name	:	LESLIE G. WEBER
Credential	:
Telephone Number	:	858-455-7127

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	08/22/2020

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