Basic Information
| Provider Information | |||||||||
| NPI: | 1356617096 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MY IMAGING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5757 WILSHIRE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900363686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236480500 | ||||||||
| FaxNumber: | 3236480508 | ||||||||
| Practice Location | |||||||||
| Address1: | 616 E ALVARADO ST STE D | ||||||||
| Address2: | |||||||||
| City: | FALLBROOK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920282350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606896100 | ||||||||
| FaxNumber: | 7606896110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | NUNEZ | ||||||||
| AuthorizedOfficialFirstName: | PERLA | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3236480500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 247100000X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | 2471C3401X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography | 2471M1202X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging | 305R00000X | CA | N | Managed Care Organizations | Preferred Provider Organization | 261QR0200X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.