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General NPI Number Information
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NPI Number | 1629033030
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Entity Type | Organization
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Legal Business Name | FUSION DIAGNOSTIC GROUP LLC
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 1700 CALIFORNIA STREET SUITE 260
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City | SAN FRANCISCO
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State | CA
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Zip | 94109
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Country | US
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Telephone | 415-921-7226
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Fax | 415-921-7225
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Provider Business Mailing Address
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Address Line | PO BOX 94592
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City | SEATTLE
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State | WA
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Zip | 98124-6892
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Country | US
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Telephone | 800-362-9772
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Fax | 206-272-3599
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Authorized Official
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Title or Position | EVP CFO OF MEMBER
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Name | NICK V DIMARTINO
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Credential |
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Telephone | 206-272-3580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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