Provider Demographics
NPI:1841432820
Name:ADVANCED CRANIOFACIAL IMAGING
Entity Type:Organization
Organization Name:ADVANCED CRANIOFACIAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELTZROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-520-6682
Mailing Address - Street 1:2615 FOREST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4383
Mailing Address - Country:US
Mailing Address - Phone:530-520-6682
Mailing Address - Fax:530-343-3482
Practice Address - Street 1:2615 FOREST AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4383
Practice Address - Country:US
Practice Address - Phone:530-520-6682
Practice Address - Fax:530-343-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory