Provider Demographics
NPI:1962427641
Name:OPEN ADVANTAGE MRI VI, INC
Entity type:Organization
Organization Name:OPEN ADVANTAGE MRI VI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-265-7027
Mailing Address - Street 1:600 N TUSTIN AVE
Mailing Address - Street 2:#100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3736
Mailing Address - Country:US
Mailing Address - Phone:916-929-2178
Mailing Address - Fax:916-929-6078
Practice Address - Street 1:800 HOWE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3911
Practice Address - Country:US
Practice Address - Phone:916-929-2178
Practice Address - Fax:916-929-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25459ZMedicare ID - Type UnspecifiedID #