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General NPI Number Information
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NPI Number | 1619068921
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Entity Type | Organization
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Legal Business Name | CLAREMONT IMAGING ASSOCIATES, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 255 E BONITA AVENUE
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City | POMONA
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State | CA
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Zip | 91769
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Country | US
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Telephone | 909-450-0393
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Fax | 909-450-0394
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Provider Business Mailing Address
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Address Line | 4100 GUARDIAN ST SUITE 205
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City | SIMI VALLEY
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State | CA
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Zip | 93063-6717
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Country | US
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Telephone | 805-577-2011
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Fax | 805-577-2018
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY JENSEN
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Credential | M.D.
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Telephone | 909-450-0393
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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 | CA
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