Provider Demographics
NPI:1003187881
Name:MAGNETIC RESONANCE IMAGING OF SAN LUIS OBISPO, INC.
Entity Type:Organization
Organization Name:MAGNETIC RESONANCE IMAGING OF SAN LUIS OBISPO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-929-1836
Mailing Address - Street 1:77 CASA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5804
Mailing Address - Country:US
Mailing Address - Phone:805-546-7733
Mailing Address - Fax:805-549-9217
Practice Address - Street 1:77 CASA ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5804
Practice Address - Country:US
Practice Address - Phone:805-546-7698
Practice Address - Fax:805-543-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty