Provider Demographics
NPI:1659418192
Name:TEMECULA VALLEY MOLECULAR IMAGING CENTER
Entity Type:Organization
Organization Name:TEMECULA VALLEY MOLECULAR IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-798-9225
Mailing Address - Street 1:25470 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:909-260-7856
Mailing Address - Fax:
Practice Address - Street 1:25470 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:909-260-7856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7603-33293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory