Provider Demographics
NPI:1518902329
Name:LOS ALAMITOS IMAGING CENTER LLC
Entity Type:Organization
Organization Name:LOS ALAMITOS IMAGING CENTER LLC
Other - Org Name:ALLIANCE MRI AT LOS ALAMITOS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-206-6198
Mailing Address - Street 1:8300 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3771 KATELLA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3108
Practice Address - Country:US
Practice Address - Phone:562-799-3276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70145FMedicaid
CAZZZ64082ZOtherBLUE SHIELD
CATD087Medicare PIN
CAEXE70145FMedicaid