Provider Demographics
NPI:1740056431
Name:NORTH COUNTY RADIOLOGY OCEANSIDE, LLC
Entity type:Organization
Organization Name:NORTH COUNTY RADIOLOGY OCEANSIDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PONEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-940-4055
Mailing Address - Street 1:3909 WARING RD STE C
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4455
Mailing Address - Country:US
Mailing Address - Phone:760-940-4055
Mailing Address - Fax:
Practice Address - Street 1:3909 WARING RD STE C
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4455
Practice Address - Country:US
Practice Address - Phone:760-940-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMAGING SERVICES ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-04
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Multi-Specialty