Healthcare Provider Details

I. General information

NPI: 1093948069
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 TIFFANY LN
COLTON CA
92324-9246
US

IV. Provider business mailing address

PO BOX 15648
SACRAMENTO CA
95852-0648
US

V. Phone/Fax

Practice location:
  • Phone: 909-872-0129
  • Fax: 909-872-0985
Mailing address:
  • Phone: 951-781-2273
  • Fax: 951-781-2293

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. DONALD R. MASSEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-719-0822