MEDICARE: ADVANCED IMAGING OF TRACY LLC

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	:	1932516754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED IMAGING OF TRACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 398076
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94139-8076
Country	:	US
Telephone Number	:	209-833-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 WEST I STREET
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	95336-5964
Country	:	US
Telephone Number	:	209-833-2393
Fax Number	:

Authorized Official
Title or Position	:	MD/PRESIDENT
Name	:	RICHARD M PORZIO
Credential	:
Telephone Number	:	209-833-2393

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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