Healthcare Provider Details

I. General information

NPI: 1720386303
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 CHICAGO AVE STE G11
RIVERSIDE CA
92507-2308
US

IV. Provider business mailing address

PO BOX 511412
LOS ANGELES CA
90051-7967
US

V. Phone/Fax

Practice location:
  • Phone: 877-411-9002
  • Fax: 855-751-0338
Mailing address:
  • Phone:
  • Fax:

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: PRESIDENT
Credential:
Phone: 951-788-3400