Healthcare Provider Details

I. General information

NPI: 1912348749
Provider Name (Legal Business Name): CITRUS VALLEY RADIOLOGISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S SUNSET AVE
WEST COVINA CA
91790-3940
US

IV. Provider business mailing address

5110 E CLINTON WAY
FRESNO CA
93727-2040
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-4011
  • Fax: 626-952-0271
Mailing address:
  • Phone: 559-455-4053
  • Fax: 770-666-9102

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: EDWARD CEFALA
Title or Position: PRESIDENT / CEO
Credential: M.D.
Phone: 626-962-4011