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
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1720386303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 511412
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-7967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 CHICAGO AVE STE G11
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2308
Country	:	US
Telephone Number	:	877-411-9002
Fax Number	:	855-751-0338

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD R. MASSEE
Credential	:
Telephone Number	:	951-788-3400

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	12/22/2021

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