Healthcare Provider Details

I. General information

NPI: 1740622729
Provider Name (Legal Business Name): DIAGNOSTIC ULTRASOUND IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N FULTON ST 202
FRESNO CA
93728-3405
US

IV. Provider business mailing address

4025 N FRESNO ST STE 105
FRESNO CA
93726-4027
US

V. Phone/Fax

Practice location:
  • Phone: 559-570-8324
  • Fax: 559-384-0500
Mailing address:
  • Phone: 559-800-6159
  • Fax: 559-384-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: VICTOR GALVAN
Title or Position: DIRECTOR
Credential: RDMS,RDCS,RVT
Phone: 559-267-3266