Basic Information
| Provider Information | |||||||||
| NPI: | 1093894628 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PET IMAGING OF NORTH COUNTY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REGENTS IMAGING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3909 WARING RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606300014 | ||||||||
| FaxNumber: | 7606300015 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 WARING RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606300014 | ||||||||
| FaxNumber: | 7606300015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAYMOND | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7605478010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 200412110106 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.