Healthcare Provider Details

I. General information

NPI: 1932855384
Provider Name (Legal Business Name): RADIOLOGY IMAGING ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W NORVELL BRYANT HWY
HERNANDO FL
34442-5288
US

IV. Provider business mailing address

PO BOX 21643
TAMPA FL
33622-1643
US

V. Phone/Fax

Practice location:
  • Phone: 352-765-2400
  • Fax:
Mailing address:
  • Phone:
  • 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: CALEB RUBEN RIVERA
Title or Position: MD
Credential: MD
Phone: 352-671-4221