Healthcare Provider Details

I. General information

NPI: 1467970533
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36750 PALMDALE RD
RANCHO MIRAGE CA
92270-2232
US

IV. Provider business mailing address

PO BOX 511412
LOS ANGELES CA
90051-7967
US

V. Phone/Fax

Practice location:
  • Phone: 801-390-1030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD R. MASSEE
Title or Position: PRESIDENT
Credential: MD
Phone: 951-788-3400