1811490089 NPI number — S S B DIAGNOSTIC IMAGING GROUP INC

Table of content: (NPI 1811490089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811490089 NPI number — S S B DIAGNOSTIC IMAGING GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S S B DIAGNOSTIC IMAGING GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SSB DIAGNOSTIC IMAGING GROUP INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811490089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 S MIDWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92027-4003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-777-2986
Provider Business Mailing Address Fax Number:
888-511-2606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 E GRAND AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-279-8172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BERON
Authorized Official First Name:
YANET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
754-777-2986

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com