MEDICARE: CORONA OPEN MRI CENTER, 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	:	1891743118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORONA OPEN MRI CENTER, LLC

Provider Business Mailing Address
First Line	:	391 N MAIN ST
Second Line	:	SUITE 110
City	:	CORONA
State	:	CA
Zip	:	92880-2001
Country	:	US
Telephone Number	:	951-340-3300
Fax Number	:	951-340-3201

Provider Business Practice Location Address
First Line	:	391 N MAIN ST
Second Line	:	SUITE 110
City	:	CORONA
State	:	CA
Zip	:	92880-2001
Country	:	US
Telephone Number	:	951-340-3300
Fax Number	:	951-340-3201

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. DONALD STANLEY
Credential	:
Telephone Number	:	951-340-3300

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/27/2012

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