Healthcare Provider Details

I. General information

NPI: 1578474789
Provider Name (Legal Business Name): VITAL PATH IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10919 CASSINA AVE
SOUTH GATE CA
90280-7642
US

IV. Provider business mailing address

10919 CASSINA AVE
SOUTH GATE CA
90280-7642
US

V. Phone/Fax

Practice location:
  • Phone: 562-375-3212
  • Fax:
Mailing address:
  • Phone: 562-375-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085H0002X
TaxonomyHospice and Palliative Medicine (Radiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC RODRIGUEZ
Title or Position: CT/ X RAY TECH
Credential: CT, XR
Phone: 562-375-3212