Provider Demographics
NPI:1508282401
Name:PACIFIC IMAGING ENTERPRISES, INC.
Entity Type:Organization
Organization Name:PACIFIC IMAGING ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:EKTEFAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-636-3455
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:SUITE 153
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6308
Mailing Address - Country:US
Mailing Address - Phone:818-654-6830
Mailing Address - Fax:818-654-6834
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 153
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-654-6830
Practice Address - Fax:818-654-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)