Healthcare Provider Details

I. General information

NPI: 1043722739
Provider Name (Legal Business Name): QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 OCEANO WAY
DAVIS CA
95618-6768
US

IV. Provider business mailing address

5110 E CLINTON WAY
FRESNO CA
93727-2040
US

V. Phone/Fax

Practice location:
  • Phone: 404-870-2802
  • Fax: 916-533-0313
Mailing address:
  • Phone: 559-455-4026
  • Fax: 916-553-0313

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: MRS. LYN MAYHUE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 559-455-4026