Healthcare Provider Details

I. General information

NPI: 1376719914
Provider Name (Legal Business Name): RADNET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2008
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35800 BOB HOPE DR SUITE 150A
RANCHO MIRAGE CA
92270-1739
US

IV. Provider business mailing address

73373 COUNTRY CLUB DR 2113
PALM DESERT CA
92260-8624
US

V. Phone/Fax

Practice location:
  • Phone: 760-770-1920
  • Fax:
Mailing address:
  • Phone: 805-236-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA111261
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number39
License Number StateOH

VIII. Authorized Official

Name: DR. NASTARAN FATEMI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-966-8509