Healthcare Provider Details

I. General information

NPI: 1144338757
Provider Name (Legal Business Name): RIVAS-SMITH IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SEQUOIA AVE STE. B
LINDSAY CA
93247-1424
US

IV. Provider business mailing address

833 SEQUOIA AVE STE. B
LINDSAY CA
93247-1424
US

V. Phone/Fax

Practice location:
  • Phone: 559-562-7172
  • Fax: 559-562-7174
Mailing address:
  • Phone: 559-562-7172
  • Fax: 559-562-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA37043
License Number StateCA

VIII. Authorized Official

Name: MISS JOY J SMITH
Title or Position: RADIOLOGY MANAGER
Credential:
Phone: 559-562-7172