Provider Demographics
NPI:1629387105
Name:SO CAL IMAGE CENTERS INC
Entity Type:Organization
Organization Name:SO CAL IMAGE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSIYIANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FSCAI
Authorized Official - Phone:951-487-6199
Mailing Address - Street 1:1695 S SAN JACINTO AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5103
Mailing Address - Country:US
Mailing Address - Phone:951-487-6199
Mailing Address - Fax:
Practice Address - Street 1:1695 S SAN JACINTO AVE
Practice Address - Street 2:SUITE N
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-487-6199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88008174400000X, 246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty