Provider Demographics
NPI:1083220842
Name:FALLBROOK IMAGING CENTER INC
Entity Type:Organization
Organization Name:FALLBROOK IMAGING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CILING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-689-6100
Mailing Address - Street 1:616 E ALVARADO ST STE E
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2350
Mailing Address - Country:US
Mailing Address - Phone:760-689-6100
Mailing Address - Fax:
Practice Address - Street 1:616 E ALVARADO ST STE D
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2350
Practice Address - Country:US
Practice Address - Phone:760-689-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty