Healthcare Provider Details

I. General information

NPI: 1013092394
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE SUITE 219
RIVERSIDE CA
92501-4090
US

IV. Provider business mailing address

PO BOX 15648
SACRAMENTO CA
95852
US

V. Phone/Fax

Practice location:
  • Phone: 951-276-7550
  • Fax: 951-276-9883
Mailing address:
  • Phone: 951-781-2270
  • Fax: 951-781-2293

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: SECRETARY
Credential: M.D.
Phone: 951-788-3400