Provider Demographics
NPI:1962754077
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/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
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:760-630-0014
Mailing Address - Fax:760-630-0015
Practice Address - Street 1:3909 WARING RD
Practice Address - Street 2:SUITE C
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4455
Practice Address - Country:US
Practice Address - Phone:760-630-0014
Practice Address - Fax:760-630-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HW529Medicare PIN