Healthcare Provider Details

I. General information

NPI: 1487943874
Provider Name (Legal Business Name): X-RAY ZONE IMAGING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 MCKINLEY DR
SANTA CLARA CA
95051-6765
US

IV. Provider business mailing address

3069 MCKINLEY DR
SANTA CLARA CA
95051-6806
US

V. Phone/Fax

Practice location:
  • Phone: 408-984-2455
  • Fax: 408-984-2456
Mailing address:
  • Phone: 408-984-2455
  • Fax: 408-984-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License NumberRHF00071304
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberRHF00071304
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberRHF00071304
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRHF00071304
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD CALVIN LEWIS
Title or Position: MANAGER
Credential: PHD
Phone: 408-625-0418