Provider Demographics
NPI:1851649628
Name:TRITON DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:TRITON DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-526-1111
Mailing Address - Street 1:149 S BARRINGTON AVE
Mailing Address - Street 2:SUITE 196
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3310
Mailing Address - Country:US
Mailing Address - Phone:310-526-1111
Mailing Address - Fax:
Practice Address - Street 1:149 S BARRINGTON AVE
Practice Address - Street 2:SUITE 196
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3310
Practice Address - Country:US
Practice Address - Phone:310-526-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty