Provider Demographics
NPI:1528019882
Name:NUCLEAR RESOURCES, INC.
Entity Type:Organization
Organization Name:NUCLEAR RESOURCES, INC.
Other - Org Name:INLAND IMAGING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-872-1151
Mailing Address - Street 1:22365 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5078
Mailing Address - Country:US
Mailing Address - Phone:909-872-1157
Mailing Address - Fax:909-872-0989
Practice Address - Street 1:22365 BARTON RD
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5015
Practice Address - Country:US
Practice Address - Phone:909-872-1157
Practice Address - Fax:909-872-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5597-36291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherBLUE CROSS PROVIDER NUMBE
CA54220ZZZ07800ZMedicare ID - Type UnspecifiedDISTRIBUTED BY BLUE SHIEL
CA=========OtherBLUE CROSS PROVIDER NUMBE