Organization
DEL AMO PET IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE MUELKEN (EXEC VP & CFO)
(800) 544-3215
Entity
Organization
Contact information
Practice address
3531 FASHION WAY, TORRANCE, CA 90503-4807
(310) 316-2424
Mailing address
100 BAYVIEW CIR, SUITE 400, NEWPORT BEACH, CA 92660-2983
(800) 544-3215
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
4834-19
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EXE70140F
—
CA
01
—
P00189215
RAILROAD MEDICARE
CA
01
—
ZZZ09162Z
BLUE SHIELD
CA
Enumeration date
06/04/2006
Last updated
09/20/2016
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