Provider Demographics
NPI:1346480183
Name:ANTIQUITES ET MEDECINE, INC.
Entity Type:Organization
Organization Name:ANTIQUITES ET MEDECINE, INC.
Other - Org Name:CITRUS EMPIRE POSITRON EMISSION TOMOGRAPHY MOBILE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSCUTOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-204-3759
Mailing Address - Street 1:11420 ETON LN
Mailing Address - Street 2:STE. A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6619
Mailing Address - Country:US
Mailing Address - Phone:951-204-3759
Mailing Address - Fax:951-787-8315
Practice Address - Street 1:399 E 21ST ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4815
Practice Address - Country:US
Practice Address - Phone:909-882-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMTCB 0049542471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty