Provider Demographics
NPI:1093894628
Name:PET IMAGING OF NORTH COUNTY, LLC
Entity Type:Organization
Organization Name:PET IMAGING OF NORTH COUNTY, LLC
Other - Org Name:REGENTS IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-547-8010
Mailing Address - Street 1:3909 WARING RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4455
Mailing Address - Country:US
Mailing Address - Phone:760-630-0014
Mailing Address - Fax:760-630-0015
Practice Address - Street 1:3909 WARING RD
Practice Address - Street 2:SUITE C
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4455
Practice Address - Country:US
Practice Address - Phone:760-630-0014
Practice Address - Fax:760-630-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200412110106261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19269Medicare PIN