Provider Demographics
NPI:1043722739
Name:QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, P.C.
Entity Type:Organization
Organization Name:QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-455-4026
Mailing Address - Street 1:5110 E CLINTON WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-2040
Mailing Address - Country:US
Mailing Address - Phone:559-455-4026
Mailing Address - Fax:916-553-0313
Practice Address - Street 1:1810 OCEANO WAY
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6768
Practice Address - Country:US
Practice Address - Phone:404-870-2802
Practice Address - Fax:916-533-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty