Healthcare Provider Details

I. General information

NPI: 1679009708
Provider Name (Legal Business Name): CALIFORNIA MEDICAL IMAGING ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 E. MERRITT AVE
TULARE CA
93274
US

IV. Provider business mailing address

2527 CRANBERRY HWY
WAREHAM MA
02571-1046
US

V. Phone/Fax

Practice location:
  • Phone: 559-366-7665
  • Fax: 559-366-7772
Mailing address:
  • Phone: 800-841-5200
  • Fax: 508-273-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: JESSE MONIZ
Title or Position: ADMINISTRATOR
Credential: CPPM
Phone: 800-841-5200