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NPI Code Detail

MEDICARE: SAN DIEGO IMAGING - CHULA VISTA, LLC

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
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center044140-06CA
2261QP3300XPain Clinic/Center044140-06CA
3261QR0206XMammography Clinic/Center044140-06CA
4261QR0200XRadiology Clinic/Center044140-06CA

Other Identifiers

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

General Provider Information

NPI Number : 1801965058
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 CT
Second Line :
City : CHULA VISTA
State : CA
Zip : 91911-6600
Country : US
Telephone Number : 858-565-0950
Fax Number : 858-244-1100
Authorized Official
Title or Position : BOARD OF DIRECTORS
Name : RICK W. PADELFORD
Credential :
Telephone Number : 858-565-0950
Provider Enumeration Date : 11/06/2006
Last Update Date : 10/27/2007

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

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