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NPI Code Detail

MEDICARE: POMONA VALLEY IMAGING MEDICAL GROUP INC

MEDICARE: POMONA VALLEY IMAGING MEDICAL GROUP INC
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
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982667911
Entity Type Code : Organization
Provider Name (Legal Business Name) : POMONA VALLEY IMAGING MEDICAL GROUP INC
Provider Business Mailing Address
First Line : 1798 N GAREY AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-2918
Country : US
Telephone Number : 909-865-9535
Fax Number : 909-397-0194
Provider Business Practice Location Address
First Line : 1798 N GAREY AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-2918
Country : US
Telephone Number : 909-825-9535
Fax Number : 909-397-0194
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHNSON BENJAMIN LIGHTFOOTE
Credential : MD
Telephone Number : 909-825-9535
Provider Enumeration Date : 04/10/2006
Last Update Date : 04/20/2008

Similar Medicare Providers

1932041886 — SUSAN LANE TENORIO
Practice Location Address:
1798 N GAREY AVE
POMONA, CA
91767-2918
Practice Phone: 909-865-9501
Practice Fax:
1265374011 — ELSA DOMINGUEZ
Practice Location Address:
1798 N GAREY AVE
POMONA, CA
91767-2918
Practice Phone: 909-865-9501
Practice Fax: 909-868-3214
1326981887 — PATRICIA GONZALEZ
Practice Location Address:
1798 N GAREY AVE
POMONA, CA
91767-2918
Practice Phone: 909-865-9501
Practice Fax: 909-868-3214
1871576363 — PAUL A REISCH MD
Practice Location Address:
1798 N GAREY AVE
POMONA, CA
91767-2918
Practice Phone: 909-865-9537
Practice Fax: 909-397-0194
1538142021 — ROBERT RING III MD
Practice Location Address:
1798 N GAREY AVE , POMONA VALLEY HOSP MEDICAL CENTER
POMONA, CA
91767-2918
Practice Phone: 909-865-9500
Practice Fax:
1124094685 — MRS. MIRIAM C. FULTON R.N., NP
Practice Location Address:
1798 N GAREY AVE
POMONA, CA
91767-2918
Practice Phone: 909-865-9850
Practice Fax: 909-623-6354

Directions to “POMONA VALLEY IMAGING MEDICAL GROUP INC ” Practice Location

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