MEDICARE: PACIFIC IMAGING, LLC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1386693109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC IMAGING, LLC

Provider Business Mailing Address
First Line	:	510 N PROSPECT AVE
Second Line	:	SUITE 101
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3028
Country	:	US
Telephone Number	:	310-265-3100
Fax Number	:	310-265-3115

Provider Business Practice Location Address
First Line	:	510 N PROSPECT AVE
Second Line	:	SUITE 101
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3028
Country	:	US
Telephone Number	:	310-265-3100
Fax Number	:	310-265-3115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN ROTONDO
Credential	:
Telephone Number	:	310-265-3100

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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