1285692970 NPI number — SIMI VALLEY MEDICAL IMAGING, LLC

Table of content: (NPI 1285692970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285692970 NPI number — SIMI VALLEY MEDICAL IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMI VALLEY MEDICAL IMAGING, LLC
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:
Provider Other Organization Name Type Code:
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:
1285692970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-6593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-637-2991
Provider Business Mailing Address Fax Number:
425-637-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1687 ERRINGER RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93065-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-527-4674
Provider Business Practice Location Address Fax Number:
805-527-4675
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIMARTINO
Authorized Official First Name:
NICK
Authorized Official Middle Name:
V
Authorized Official Title or Position:
CFO & EXECUTIVE VP
Authorized Official Telephone Number:
425-637-2991

Provider Taxonomy Codes

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

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

  • Identifier: GR0056261 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com