Provider Demographics
NPI:1275799231
Name:CONSOLIDATED IMAGING OF WINNETKA LLC
Entity Type:Organization
Organization Name:CONSOLIDATED IMAGING OF WINNETKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-908-2555
Mailing Address - Street 1:7111 WINNETKA AVENUE
Mailing Address - Street 2:SUITE # 16
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3646
Mailing Address - Country:US
Mailing Address - Phone:818-436-7409
Mailing Address - Fax:818-436-7513
Practice Address - Street 1:7111 WINNETKA AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-3646
Practice Address - Country:US
Practice Address - Phone:818-436-7409
Practice Address - Fax:818-436-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)