Healthcare Provider Details

I. General information

NPI: 1689628679
Provider Name (Legal Business Name): CALIFORNIA ADVANCED IMAGING MEDICAL ASSOC., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S ELISEO DR STE 101
GREENBRAE CA
94904-2009
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 415-464-8080
  • Fax: 415-461-2012
Mailing address:
  • Phone: 415-884-3418
  • Fax: 415-883-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KELLY HOYE
Title or Position: CEO
Credential:
Phone: 415-884-3448