MEDICARE: CENTER FOR ADVANCED IMAGING LLC

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	261QR0206X	Mammography Clinic/Center	63575	CA

General Provider Information

NPI Number	:	1578510434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR ADVANCED IMAGING LLC

Provider Business Mailing Address
First Line	:	2375 MONTPELIER DR
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1614
Country	:	US
Telephone Number	:	408-926-6235
Fax Number	:	408-926-9856

Provider Business Practice Location Address
First Line	:	2375 MONTPELIER DR
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1614
Country	:	US
Telephone Number	:	408-926-6235
Fax Number	:	408-926-9856

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. TOM MAY
Credential	:
Telephone Number	:	702-938-9601

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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