MEDICARE: SAN DIEGO IMAGING-CHULA VISTA 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	04414006	CA
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	05138506	CA
3	261QR0200X	Radiology Clinic/Center	05158506	CA
4	261QR0206X	Mammography Clinic/Center	04414006	CA
5	261QR0200X	Radiology Clinic/Center	04414006	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649207812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO IMAGING-CHULA VISTA LLC

Provider Business Mailing Address
First Line	:	PO BOX 939054
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-9054
Country	:	US
Telephone Number	:	858-565-0950
Fax Number	:	858-244-1100

Provider Business Practice Location Address
First Line	:	765 MEDICAL CENTER COURT
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911
Country	:	US
Telephone Number	:	619-397-6577
Fax Number	:	619-502-8585

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RICK W PADELFORD
Credential	:
Telephone Number	:	858-565-0950

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	12/18/2015

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Directions to “SAN DIEGO IMAGING-CHULA VISTA LLC ” Practice Location

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