Healthcare Provider Details

I. General information

NPI: 1982605432
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

PO BOX 15648
SACRAMENTO CA
95852-0648
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax: 760-242-3306
Mailing address:
  • Phone: 951-781-2270
  • Fax: 951-781-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DONALD R. MASSEE
Title or Position: PRESIDENT
Credential: MD.
Phone: 951-781-2270