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General NPI Number Information
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NPI Number | 1497185599
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN IMAGING
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 1107 W POPLAR AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-5839
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Country | US
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Telephone | 209-781-7242
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Fax |
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Provider Business Mailing Address
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Address Line | 4536 BROADWAY UNIT 906
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City | SALIDA
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State | CA
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Zip | 95368-2037
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Country | US
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Telephone | 209-577-9900
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Fax | 209-577-1509
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Authorized Official
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Title or Position | ADMIN
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Name | DAVID WILSON
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Credential |
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Telephone | 209-577-9900
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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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