MEDICARE: ALVARADO RADIOLOGY GROUP INC, A PROFESSIONAL CORPORATION

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1528522620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALVARADO RADIOLOGY GROUP INC, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 2039
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99302-2039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 PAPERBARK
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-3442
Country	:	US
Telephone Number	:	559-455-4009
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SANDIP PATIDAR
Credential	:	MD
Telephone Number	:	559-455-4009

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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