Basic Information
| Provider Information | |||||||||
| NPI: | 1396941233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC COAST IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5329 | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486030329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0334371285 | ||||||||
| FaxNumber: | 5033437129 | ||||||||
| Practice Location | |||||||||
| Address1: | 2111 EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033387525 | ||||||||
| FaxNumber: | 5033251765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | SABAHI | ||||||||
| AuthorizedOfficialFirstName: | HOUMAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PREIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5033387525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.