Healthcare Provider Details

I. General information

NPI: 1558516179
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 IOWA AVE 280
RIVERSIDE CA
92507-2430
US

IV. Provider business mailing address

PO BOX 15648
SACRAMENTO CA
95852-0648
US

V. Phone/Fax

Practice location:
  • Phone: 951-801-6348
  • Fax: 951-786-0460
Mailing address:
  • Phone: 559-455-4000
  • Fax: 559-455-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONALD R. MASSEE
Title or Position: MEDICAL DIRECTOR
Credential: MD.
Phone: 951-781-2270