Healthcare Provider Details

I. General information

NPI: 1770426082
Provider Name (Legal Business Name): GOLDEN VALLEY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17274 GOLDEN VALLEY PKWY
LATHROP CA
95330-8674
US

IV. Provider business mailing address

145 TREVINO AVE
MANTECA CA
95337-4200
US

V. Phone/Fax

Practice location:
  • Phone: 209-756-4832
  • Fax: 209-554-4371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEVEN ROY
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-756-4832