Provider Demographics
NPI:1093552689
Name:SADDLEBACK PORTABLE X-RAY LLC
Entity type:Organization
Organization Name:SADDLEBACK PORTABLE X-RAY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:949-289-2538
Mailing Address - Street 1:1651 E 4TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5142
Mailing Address - Country:US
Mailing Address - Phone:714-835-2915
Mailing Address - Fax:714-543-3114
Practice Address - Street 1:1651 E 4TH ST STE 212
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5142
Practice Address - Country:US
Practice Address - Phone:714-835-2915
Practice Address - Fax:714-543-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty