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General NPI Number Information
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NPI Number | 1144428350
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Entity Type | Organization
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Legal Business Name | RENAISSANCE RADIOLOGY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 2224 MEDICAL CENTER DR
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City | PERRIS
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State | CA
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Zip | 92571-2638
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Country | US
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Telephone | 909-570-3108
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 ROYALTY DR SUITE 220
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City | POMONA
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State | CA
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Zip | 91767-3030
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Country | US
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Telephone | 909-570-3108
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | LINDA S. KAUFMAN
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Credential |
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Telephone | 909-570-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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