Healthcare Provider Details

I. General information

NPI: 1801897731
Provider Name (Legal Business Name): DONALD R MASSEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/16/2008
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 15648
SACRAMENTO CA
95852-0648
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3400
  • Fax: 951-788-3194
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 NumberG60908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: