Healthcare Provider Details

I. General information

NPI: 1316362239
Provider Name (Legal Business Name): SOLANO DIAGNOSTICS IMAGING MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N PALM DR # 4C
BEVERLY HILLS CA
90210-4184
US

IV. Provider business mailing address

4500 BUSINESS CENTER DR
FAIRFIELD CA
94534-6888
US

V. Phone/Fax

Practice location:
  • Phone: 818-606-3951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELNORA CAMERON
Title or Position: PRESIDENT
Credential:
Phone: 707-646-3288