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General NPI Number Information
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NPI Number | 1558337444
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Entity Type | Organization
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Legal Business Name | HEMET VALLEY IMAGING MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 1001 E LATHAM AVE STE G
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City | HEMET
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State | CA
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Zip | 92543-4435
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Country | US
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Telephone | 951-658-9243
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 E LATHAM AVE STE G
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City | HEMET
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State | CA
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Zip | 92543-4435
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Country | US
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Telephone | 951-658-9243
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Fax | 951-765-5415
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Authorized Official
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Title or Position | MEDICAL DIRECTOR / PRESIDENT
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Name | DR. FREDERICK EUGENE WHITE
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Credential | D.O.
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Telephone | 951-658-9243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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