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Organization
BACK BAY IMAGING INC.
Active
Organization
BACK BAY IMAGING INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT PETZOLD (MANAGER)
(310) 736-4395
Entity
Organization
Contact information
Practice address
301 BAYVIEW CIR, SUITE 105, NEWPORT BEACH, CA 92660-2948
(310) 736-4395
Mailing address
4640 ADMIRALTY WAY, SUITE 102, MARINA DEL REY, CA 90292-6621
(310) 736-4395
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
01/23/2017
Last updated
01/30/2017
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