MEDICARE: RENAISSANCE 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 State
1	2085R0202X	Diagnostic Radiology Physician	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	CA
3	2085U0001X	Diagnostic Ultrasound Physician	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	:	1619951134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE RADIOLOGY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	1902 ROYALTY DR
Second Line	:	SUITE 220
City	:	POMONA
State	:	CA
Zip	:	91767-3030
Country	:	US
Telephone Number	:	909-620-8180
Fax Number	:	909-469-6741

Provider Business Practice Location Address
First Line	:	5451 WALNUT AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-2609
Country	:	US
Telephone Number	:	909-620-8180
Fax Number	:	909-469-6741

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	DR. MONIKA KIEF GARCIA
Credential	:	M.D.
Telephone Number	:	909-620-8180

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/11/2025

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