Healthcare Provider Details
I. General information
NPI: 1003965997
Provider Name (Legal Business Name): NORCAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/09/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2600 PARK AVE. , SUITES # 101 & 203
CONCORD CA
94520-1929
US
IV. Provider business mailing address
1516 COTNER AVE
LOS ANGELES CA
90025-3303
US
V. Phone/Fax
- Phone: 925-825-7226
- Fax: 925-825-7658
- Phone: 310-445-2951
- Fax: 310-479-1459
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
HOWARD
G.
BERGER
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 310-445-2800