Provider Demographics
NPI:1891982484
Name:FULL BODY SCANNING OF ORANGE COUNTY LLC
Entity Type:Organization
Organization Name:FULL BODY SCANNING OF ORANGE COUNTY LLC
Other - Org Name:STELLAR MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-778-3913
Mailing Address - Street 1:8677 VIA LA JOLLA DR
Mailing Address - Street 2:#1252
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:949-706-6470
Mailing Address - Fax:858-272-0698
Practice Address - Street 1:3 CORPORATE PLAZA
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-726-6470
Practice Address - Fax:858-272-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)