Healthcare Provider Details

I. General information

NPI: 1851694699
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 LOWELL AVE
MILL VALLEY CA
94941-3845
US

IV. Provider business mailing address

1660 CHICAGO AVE STE M17
RIVERSIDE CA
92507-2033
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-4041
  • Fax: 770-666-9102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD R. MASSEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-781-2273