MEDICARE: VALLEJO OPEN MRI CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1164478277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEJO OPEN MRI CENTER

Provider Business Mailing Address
First Line	:	1516 COTNER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3303
Country	:	US
Telephone Number	:	310-445-2951
Fax Number	:	310-479-1459

Provider Business Practice Location Address
First Line	:	155 GLEN COVE MARINA RD E
Second Line	:	SUITE 101
City	:	VALLEJO
State	:	CA
Zip	:	94591-7284
Country	:	US
Telephone Number	:	707-644-1292
Fax Number	:	707-644-1362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HOWARD G. BERGER
Credential	:	MD
Telephone Number	:	310-445-2800

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	10/26/2007

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Directions to “VALLEJO OPEN MRI CENTER ” Practice Location

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