Organization
IMAGING CENTERS DIRECT LLC
Active
Other names
Dedicated Medical Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA BRENES (PART OWNER)
(714) 547-3200
Entity
Organization
Contact information
Practice address
1125 E 17TH STREET, STE W125, SANTA ANA, CA 92701
(714) 547-3200
(714) 547-7249
Mailing address
1125 E 17TH STREET, STE W125, SANTA ANA, CA 92701
(714) 547-3200
(714) 547-7249
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G475810
—
CA
05
—
GR0059280
—
CA
Enumeration date
11/30/2006
Last updated
10/14/2011
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