Provider Demographics
NPI:1093240004
Name:EMANATE HEALTH IMAGING
Entity Type:Organization
Organization Name:EMANATE HEALTH IMAGING
Other - Org Name:CITRUS DIAGNOSTIC IMAGING CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-236-8371
Mailing Address - Street 1:210 W. SAN BERNARDINO ROAD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1515
Mailing Address - Country:US
Mailing Address - Phone:626-732-3159
Mailing Address - Fax:626-732-3194
Practice Address - Street 1:828 S GRAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-963-2057
Practice Address - Fax:626-963-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty