Healthcare Provider Details

I. General information

NPI: 1740461821
Provider Name (Legal Business Name): NORTH VALLEY PORTABLE X-RAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2007
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 RENZ RD
DURHAM CA
95938-9627
US

IV. Provider business mailing address

PO BOX 1220
DURHAM CA
95938-1220
US

V. Phone/Fax

Practice location:
  • Phone: 530-895-3178
  • Fax: 530-895-8731
Mailing address:
  • Phone: 530-895-3178
  • Fax: 530-895-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberFAC41966
License Number StateCA

VIII. Authorized Official

Name: MS. SUSAN MARIE DAVIN HANCOCK
Title or Position: OWNER
Credential: CRT
Phone: 530-895-3178