Healthcare Provider Details

I. General information

NPI: 1376867309
Provider Name (Legal Business Name): VALLEY DIAGNOSTIC IMAGING MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE UNIT 210
PASADENA CA
91105-3278
US

IV. Provider business mailing address

1624 W OLIVE AVE SUITE F
BURBANK CA
91506-2459
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-2835
  • Fax: 818-843-3310
Mailing address:
  • Phone: 818-843-2835
  • Fax: 818-843-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT JOHN CASSLING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-843-2835