Healthcare Provider Details

I. General information

NPI: 1669123626
Provider Name (Legal Business Name): ADVANCED RADIOLOGY AND INTERVENTIONAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CALIFORNIA ST
STOCKTON CA
95204-6019
US

IV. Provider business mailing address

450 GLASS LN STE C
MODESTO CA
95356-9287
US

V. Phone/Fax

Practice location:
  • Phone: 209-943-2000
  • Fax:
Mailing address:
  • Phone: 209-342-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PARDEEP ATHWAL
Title or Position: CEO
Credential: MD
Phone: 209-342-2300