Provider Demographics
NPI:1609814102
Name:DEL AMO PET IMAGING CENTER LLC
Entity Type:Organization
Organization Name:DEL AMO PET IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:100 BAYVIEW CIR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2983
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:3531 FASHION WAY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4807
Practice Address - Country:US
Practice Address - Phone:310-316-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4834-19261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70140FMedicaid
CAP00189215OtherRAILROAD MEDICARE
CAZZZ09162ZOtherBLUE SHIELD
CAP00189215OtherRAILROAD MEDICARE