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		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	:	1982605432
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	:	951-781-2270
Fax Number	:	951-781-2293

Provider Business Practice Location Address
First Line	:	18300 US HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2206
Country	:	US
Telephone Number	:	760-242-2311
Fax Number	:	760-242-3306

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD R. MASSEE
Credential	:	MD.
Telephone Number	:	951-781-2270

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/21/2022

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