Organization
WEST COAST PETCT
Active
Parent organization
WEST COAST RADIOLOGY, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST COAST RADIOLOGY, INC.
Authorized official
MICHAEL L. BLACK M.D. (MEDICAL DIRECTOR)
(714) 835-6055
Entity
Organization
Contact information
Practice address
16300 SAND CANYON AVE, SUITE 103, IRVINE, CA 92618-3711
(714) 835-6055
Mailing address
16300 SAND CANYON AVE, SUITE 103, IRVINE, CA 92618-3711
(714) 835-6055
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2009
Last updated
09/29/2009
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