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General NPI Number Information
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NPI Number | 1740461821
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Entity Type | Organization
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Legal Business Name | NORTH VALLEY PORTABLE X-RAY
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Dates
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Enumeration Date | 11/17/2007
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 2095 RENZ RD
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City | DURHAM
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State | CA
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Zip | 95938-9627
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Country | US
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Telephone | 530-895-3178
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Fax | 530-895-8731
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Provider Business Mailing Address
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Address Line | PO BOX 1220
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City | DURHAM
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State | CA
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Zip | 95938-1220
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Country | US
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Telephone | 530-895-3178
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Fax | 530-895-8731
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN MARIE DAVIN HANCOCK
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Credential | CRT
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Telephone | 530-895-3178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | FAC41966
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License Number State | CA
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