Provider Demographics
NPI:1386693109
Name:PACIFIC IMAGING, LLC
Entity type:Organization
Organization Name:PACIFIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-265-3100
Mailing Address - Street 1:510 N PROSPECT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3028
Mailing Address - Country:US
Mailing Address - Phone:310-265-3100
Mailing Address - Fax:310-265-3115
Practice Address - Street 1:510 N PROSPECT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3028
Practice Address - Country:US
Practice Address - Phone:310-265-3100
Practice Address - Fax:310-265-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATP112Medicare ID - Type Unspecified