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General NPI Number Information
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NPI Number | 1568756096
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Entity Type | Organization
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Legal Business Name | VALLEY MRI AND RADIOLOGY INC
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 546 E PINE ST
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City | STOCKTON
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State | CA
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Zip | 95204-5525
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Country | US
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Telephone | 209-467-1000
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Fax | 209-467-7335
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Provider Business Mailing Address
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Address Line | 546 E PINE ST
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City | STOCKTON
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State | CA
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Zip | 95204-5525
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Country | US
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Telephone | 209-467-1000
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Fax | 209-467-7335
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES ALLEN STILLMAN
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Credential | D.O.
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Telephone | 209-467-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | C35905
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C35905
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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