Healthcare Provider Details

I. General information

NPI: 1801851340
Provider Name (Legal Business Name): EAST BAY MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 CAMINO RAMON STE 100
SAN RAMON CA
94583-1352
US

IV. Provider business mailing address

PO BOX 404166 LEGAL DEPT
ATLANTA GA
30384-4166
US

V. Phone/Fax

Practice location:
  • Phone: 925-327-0015
  • Fax: 925-327-0095
Mailing address:
  • Phone: 949-282-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRIAN G DRAZBA
Title or Position: SENIOR VP & CHIEF ACCOUNTING OFCR
Credential:
Phone: 949-282-6000