Provider Demographics
NPI:1003840042
Name:WOODWARD PARK RADIOLOGY CENTER MED. GRP
Entity Type:Organization
Organization Name:WOODWARD PARK RADIOLOGY CENTER MED. GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-2800
Mailing Address - Street 1:79 SCRIPPS DR
Mailing Address - Street 2:100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6208
Mailing Address - Country:US
Mailing Address - Phone:916-921-1300
Mailing Address - Fax:916-921-1095
Practice Address - Street 1:7055 N FRESNO ST
Practice Address - Street 2:203
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2957
Practice Address - Country:US
Practice Address - Phone:559-437-1880
Practice Address - Fax:559-437-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55191ZOtherBLUE SHIELD
CAGR0081040Medicaid
CAGR0081040Medicaid