Provider Demographics
NPI:1891743118
Name:CORONA OPEN MRI CENTER, LLC
Entity Type:Organization
Organization Name:CORONA OPEN MRI CENTER, LLC
Other - Org Name:LIFESCAPE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-340-3300
Mailing Address - Street 1:391 N MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-2001
Mailing Address - Country:US
Mailing Address - Phone:951-340-3300
Mailing Address - Fax:951-340-3201
Practice Address - Street 1:391 N MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-2001
Practice Address - Country:US
Practice Address - Phone:951-340-3300
Practice Address - Fax:951-340-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ230012Medicare ID - Type Unspecified