Healthcare Provider Details

I. General information

NPI: 1376596742
Provider Name (Legal Business Name): RCOA-ADVENTIST HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREENLEY RD
SONORA CA
95370-5200
US

IV. Provider business mailing address

P. O. BOX 85001
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 866-293-3500
  • Fax: 866-293-3535
Mailing address:
  • Phone: 866-293-3500
  • Fax: 866-293-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number6838-17
License Number StateCA

VIII. Authorized Official

Name: MR. DERRICK R MOORE
Title or Position: VP OF ACCOUNTING AND FINANCE
Credential:
Phone: 561-477-3500