Healthcare Provider Details

I. General information

NPI: 1952858912
Provider Name (Legal Business Name): NEW TECHNOLOGY MEDICAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E 5TH ST
BENICIA CA
94510-3502
US

IV. Provider business mailing address

1208 E 5TH ST
BENICIA CA
94510-3502
US

V. Phone/Fax

Practice location:
  • Phone: 707-745-3112
  • Fax: 707-745-6822
Mailing address:
  • Phone: 707-745-3112
  • Fax: 707-745-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA44609
License Number StateCA

VIII. Authorized Official

Name: DR. ARUN ANAND
Title or Position: CEO
Credential: MD
Phone: 707-745-3112