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NPI Code Detail

MEDICARE: RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.

MEDICARE: RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
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
12085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1518267384
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : PO BOX 15648
Second Line :
City : SACRAMENTO
State : CA
Zip : 95852-0648
Country : US
Telephone Number : 951-781-2273
Fax Number :
Provider Business Practice Location Address
First Line : 7410 YONIE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-2159
Country : US
Telephone Number : 559-455-4000
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : DONALD R. MASSEE
Credential :
Telephone Number : 951-781-2273
Provider Enumeration Date : 10/27/2010
Last Update Date : 10/27/2010

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Directions to “RIVERSIDE RADIOLOGY MEDICAL GROUP, INC. ” Practice Location

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