MEDICARE: CITY IMAGING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	DC24364	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316007537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY IMAGING

Provider Business Mailing Address
First Line	:	2588 MISSION ST
Second Line	:	SUITE 201
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2592
Country	:	US
Telephone Number	:	415-647-2163
Fax Number	:	415-695-0673

Provider Business Practice Location Address
First Line	:	2588 MISSION ST
Second Line	:	SUITE 201
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2592
Country	:	US
Telephone Number	:	415-647-2163
Fax Number	:	415-695-0673

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MANUEL M FONSECA
Credential	:	DC
Telephone Number	:	415-647-2163

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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Directions to “CITY IMAGING ” Practice Location

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