Healthcare Provider Details

I. General information

NPI: 1306137146
Provider Name (Legal Business Name): COLIMA RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 COLIMA RD
WHITTIER CA
90605-1600
US

IV. Provider business mailing address

PO BOX 39000
SAN FRANCISCO CA
94139-0001
US

V. Phone/Fax

Practice location:
  • Phone: 562-945-3561
  • Fax:
Mailing address:
  • Phone: 805-578-8300
  • Fax: 805-578-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BAY NGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-945-3561