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General NPI Number Information
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NPI Number | 1588499040
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Entity Type | Organization
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Legal Business Name | ADVANCED IMAGING RENO
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 5420 KIETZKE LN STE 108
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City | RENO
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State | NV
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Zip | 89511-2063
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Country | US
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Telephone | 775-507-3331
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Fax | 775-540-5988
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Provider Business Mailing Address
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Address Line | 5420 KIETZKE LN STE 209
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City | RENO
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State | NV
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Zip | 89511-2062
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Country | US
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Telephone | 775-507-3331
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Fax | 775-540-5988
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Authorized Official
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Title or Position | OWNER
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Name | RANDALL GATES
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Credential | DC
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Telephone | 775-413-3263
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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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