Provider Demographics
NPI:1053538660
Name:SANTA CLARA IMAGING CENTER, LLC
Entity type:Organization
Organization Name:SANTA CLARA IMAGING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHEMIEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-296-5555
Mailing Address - Street 1:1825 CIVIC CENTER DRIVE
Mailing Address - Street 2:1
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050
Mailing Address - Country:US
Mailing Address - Phone:408-296-5555
Mailing Address - Fax:408-296-5556
Practice Address - Street 1:1825 CIVIC CENTER DRIVE
Practice Address - Street 2:1
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050
Practice Address - Country:US
Practice Address - Phone:408-296-5555
Practice Address - Fax:408-296-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology