Healthcare Provider Details

I. General information

NPI: 1750522132
Provider Name (Legal Business Name): NORTH VALLEY ADVANCED IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 ESPLANADE
CHICO CA
95926-3313
US

IV. Provider business mailing address

1720 ESPLANADE
CHICO CA
95926-3315
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-6067
  • Fax: 530-345-4505
Mailing address:
  • Phone: 530-898-0504
  • Fax: 530-898-9647

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: DR. GREGORY LAUTEN
Title or Position: MEDICAL DIRETOR
Credential: M.D.
Phone: 530-898-0504