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Organization

COASTAL IMAGE GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ELLEN TERESA SONG M.D. (PRESIDENT)
(714) 904-5594
Entity
Organization

Contact information

Practice address
62 CORPORATE PARK STE 120, IRVINE, CA 92606-3142
(949) 701-3394
(949) 748-8868
Mailing address
62 CORPORATE PARK STE 120, IRVINE, CA 92606-3142
(949) 701-3394
(949) 748-8868

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A86825
CA
2085U0001X
Diagnostic Ultrasound Physician
Primary
A86825
CA

Other

Enumeration date
01/03/2009
Last updated
01/03/2009
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