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General NPI Number Information
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NPI Number | 1538566104
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Entity Type | Organization
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Legal Business Name | ONLINE RADIOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 1770 IOWA AVE 280
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City | RIVERSIDE
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State | CA
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Zip | 92507-2430
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Country | US
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Telephone | 951-786-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 12700 CENTERVILLE RD
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City | CHICO
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State | CA
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Zip | 95928-8328
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Country | US
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Telephone | 530-895-0926
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SAMUEL SALEN
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Credential |
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Telephone | 951-786-0801
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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 | G37314
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License Number State | CA
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