Healthcare Provider Details

I. General information

NPI: 1902357403
Provider Name (Legal Business Name): REGIONAL DIAGNOSTIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BALD EAGLE DR
VACAVILLE CA
95688-1019
US

IV. Provider business mailing address

PO BOX 26570
FRESNO CA
93729-6570
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-4138
  • Fax:
Mailing address:
  • Phone: 559-455-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HARMANDEEP K GILL
Title or Position: AUTHORIZED OFFICAL
Credential: M.D.
Phone: 559-455-4138