Healthcare Provider Details

I. General information

NPI: 1790378016
Provider Name (Legal Business Name): RIVERSIDE ELITE IMAGING , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21828 CACTUS AVE
RIVERSIDE CA
92518-3010
US

IV. Provider business mailing address

21828 CACTUS AVE
RIVERSIDE CA
92518-3010
US

V. Phone/Fax

Practice location:
  • Phone: 951-900-3000
  • Fax: 951-900-1234
Mailing address:
  • Phone: 951-900-3000
  • Fax: 951-900-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FADY ALAM
Title or Position: OWNER
Credential:
Phone: 951-900-3000