Healthcare Provider Details

I. General information

NPI: 1699737478
Provider Name (Legal Business Name): RIVERSIDE MEDICAL IMAGING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10111 HOLE AVE
RIVERSIDE CA
92503-3441
US

IV. Provider business mailing address

10111 HOLE AVE
RIVERSIDE CA
92503-3441
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-0555
  • Fax: 951-352-9780
Mailing address:
  • Phone: 951-352-0555
  • Fax: 951-352-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LISA BROCKETT
Title or Position: CEO
Credential:
Phone: 949-250-4500