Healthcare Provider Details

I. General information

NPI: 1629033030
Provider Name (Legal Business Name): FUSION DIAGNOSTIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CALIFORNIA STREET SUITE 260
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

PO BOX 94592
SEATTLE WA
98124-6892
US

V. Phone/Fax

Practice location:
  • Phone: 415-921-7226
  • Fax: 415-921-7225
Mailing address:
  • Phone: 800-362-9772
  • Fax: 206-272-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICK V DIMARTINO
Title or Position: EVP CFO OF MEMBER
Credential:
Phone: 206-272-3580