Provider Demographics
NPI:1538121405
Name:IMPERIAL MEDICAL IMAGING
Entity Type:Organization
Organization Name:IMPERIAL MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-250-4500
Mailing Address - Street 1:3 UPPER NEWPORT PLZ
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2630
Mailing Address - Country:US
Mailing Address - Phone:949-250-4500
Mailing Address - Fax:949-250-4501
Practice Address - Street 1:17451 BASTANCHURY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1857
Practice Address - Country:US
Practice Address - Phone:714-961-9300
Practice Address - Fax:714-961-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology