Provider Demographics
NPI:1619000338
Name:INTIMATE IMAGE #2, INC.
Entity Type:Organization
Organization Name:INTIMATE IMAGE #2, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WORKING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-835-9656
Mailing Address - Street 1:2425 N TUSTIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1610
Mailing Address - Country:US
Mailing Address - Phone:714-835-9656
Mailing Address - Fax:714-835-9650
Practice Address - Street 1:2425 N TUSTIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1610
Practice Address - Country:US
Practice Address - Phone:714-835-9656
Practice Address - Fax:714-835-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies