Provider Demographics
NPI:1881811578
Name:PRO SCAN MEDICAL IMAGING LLC
Entity type:Organization
Organization Name:PRO SCAN MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-582-3792
Mailing Address - Street 1:5200 WILDROSE LN
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1600
Mailing Address - Country:US
Mailing Address - Phone:510-582-3792
Mailing Address - Fax:
Practice Address - Street 1:929 JEFFERSON ST
Practice Address - Street 2:#D
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2296
Practice Address - Country:US
Practice Address - Phone:661-721-2658
Practice Address - Fax:661-721-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology