Basic Information
| Provider Information | |||||||||
| NPI: | 1760731244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN CALIFORNIA IMAGIN CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 NW 66TH AVE | ||||||||
| Address2: | SUITE 200A | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333134571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004433672 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13132 STUDEBAKER RD STE A | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906502573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629297216 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2012 | ||||||||
| LastUpdateDate: | 08/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | GIONIS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9494001799 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | C2943567 | CA | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric | 313M00000X | C2943567 | CA | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.