Molecular Imaging Sorrento Valley, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

B2003020474 Issued in CA

Legal business name

MOLECULAR IMAGING SORRENTO VALLEY, LLC

Doing business as

Ucsd Center for Molecular Imaging

Practice address

11388 Sorrento Valley Rd
Suite 100
San Diego, CA 92121-1345

Phone

(858) 373-2860

Fax

(858) 373-2865

NPI assigned

May 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth C Frederick

Title

Ceo

Phone

(858) 642-0032

Specialties & licenses 1

Addresses

Other names 1

• UCSD CENTER FOR MOLECULAR IMAGING Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1437108776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9530 TOWNE CENTRE DR",
            "address_2": "SUITE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211981",
            "telephone_number": "858-642-0032",
            "fax_number": "858-642-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11388 SORRENTO VALLEY RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211345",
            "telephone_number": "858-373-2860",
            "fax_number": "858-373-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLECULAR IMAGING SORRENTO VALLEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-642-0032",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "CA",
            "license": "B2003020474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCSD CENTER FOR MOLECULAR IMAGING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Candice Badri Molavi
• Daniel P Molden, M.D.
• C. Craig Moldenhauer, M.D.
• Matthew Moldenhauer
• Molecular Imaging Corporation
• John Paul Molenaar, MA, F-AAA
• Rene John Molenkamp, LPCC
• Darcy Denise Molett
• Sophia Karan Molina Martinez
• Molina Physical Therapy Inc

• Radiology Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Radiology Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.