Provider Demographics
NPI:1497913370
Name:CORONA ADVANCED IMAGING CENTER
Entity Type:Organization
Organization Name:CORONA ADVANCED IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-256-6307
Mailing Address - Street 1:886 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3105
Mailing Address - Country:US
Mailing Address - Phone:951-340-0129
Mailing Address - Fax:951-340-4875
Practice Address - Street 1:886 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3105
Practice Address - Country:US
Practice Address - Phone:951-340-0129
Practice Address - Fax:951-340-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631703305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization