MEDICARE: ORANGE COUNTY SPINAL IMAGING INC

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	2471C3402X	Radiography Radiologic Technologist	RHC147719	CA

General Provider Information

NPI Number	:	1649483553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE COUNTY SPINAL IMAGING INC

Provider Business Mailing Address
First Line	:	3145 E ABBEY LN
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-2009
Country	:	US
Telephone Number	:	949-552-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	3145 E ABBEY LN
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-2009
Country	:	US
Telephone Number	:	949-552-7246
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN J DONOGHUE
Credential	:	M.D.
Telephone Number	:	714-538-4088

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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