Basic Information
| Provider Information | |||||||||
| NPI: | 1326152604 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SD IMAGING GROUP, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED MRI & CT OF ESCONDIDO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 N ELM ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607433873 | ||||||||
| FaxNumber: | 7607433874 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 N ELM ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607433873 | ||||||||
| FaxNumber: | 7607433874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | JODIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7607433873 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.