Provider Demographics
NPI:1760731244
Name:SOUTHERN CALIFORNIA IMAGIN CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA IMAGIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-400-1799
Mailing Address - Street 1:1801 NW 66TH AVE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4571
Mailing Address - Country:US
Mailing Address - Phone:800-443-3672
Mailing Address - Fax:
Practice Address - Street 1:13132 STUDEBAKER RD STE A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2573
Practice Address - Country:US
Practice Address - Phone:562-929-7216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2943567313M00000X, 3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric