Basic Information
| Provider Information | |||||||||
| NPI: | 1780312371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO IMAGING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 23540 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921933540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585650950 | ||||||||
| FaxNumber: | 8585652863 | ||||||||
| Practice Location | |||||||||
| Address1: | 7910 FROST STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586345900 | ||||||||
| FaxNumber: | 8586345990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2022 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHEN | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8585650950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.