Provider Demographics
NPI:1639363856
Name:INLAND IMAGING SERVICES
Entity Type:Organization
Organization Name:INLAND IMAGING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:BACA
Authorized Official - Suffix:
Authorized Official - Credentials:RPA
Authorized Official - Phone:303-944-3764
Mailing Address - Street 1:29822 SEA BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7981
Mailing Address - Country:US
Mailing Address - Phone:303-944-3764
Mailing Address - Fax:
Practice Address - Street 1:13330 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3251
Practice Address - Country:US
Practice Address - Phone:562-674-2911
Practice Address - Fax:562-674-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05CO1119247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty