Healthcare Provider Details

I. General information

NPI: 1699776526
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

PO BOX 511412
LOS ANGELES CA
90051-7967
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3400
  • Fax: 951-788-3194
Mailing address:
  • Phone: 877-411-9002
  • Fax: 559-455-4016

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: DONAL R. MASSEE
Title or Position: PRESIDENT
Credential: MD.
Phone: 951-781-2270