Healthcare Provider Details

I. General information

NPI: 1619943537
Provider Name (Legal Business Name): HEMET RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

235 LAURSEN ST
HEMET CA
92543-4437
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-2811
  • Fax: 951-765-4986
Mailing address:
  • Phone: 951-765-5417
  • Fax: 951-765-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK EUGENE WHITE
Title or Position: MEDICAL DIRECTOR / PRESIDENT
Credential: D.O.
Phone: 951-765-5417