Healthcare Provider Details

I. General information

NPI: 1275523169
Provider Name (Legal Business Name): CENTRAL VALLEY IMAGING MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CHERRY LN STE 116
MANTECA CA
95337-4398
US

IV. Provider business mailing address

PO BOX 398076
SAN FRANCISCO CA
94139-8076
US

V. Phone/Fax

Practice location:
  • Phone: 209-647-2184
  • Fax:
Mailing address:
  • Phone: 209-647-2184
  • Fax: 209-647-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number71935
License Number StateCA

VIII. Authorized Official

Name: RICHARD M PORZIO
Title or Position: PRESIDENT
Credential: MD
Phone: 209-647-2184