Basic Information
| Provider Information | |||||||||
| NPI: | 1992708366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SD IMAGING, LLC | ||||||||
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| OtherOrganizationName: | ADVANCED MRI OF ESCONDIDO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 N ELM ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607433873 | ||||||||
| FaxNumber: | 7607433874 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 N ELM ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607433873 | ||||||||
| FaxNumber: | 7607433874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WAKEMAN | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7607433873 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471M1202X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging |
No ID Information.