Provider Demographics
NPI:1235737651
Name:EL DORADO IMAGING LLC
Entity Type:Organization
Organization Name:EL DORADO IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-715-7374
Mailing Address - Street 1:2574 RALEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-6973
Mailing Address - Country:US
Mailing Address - Phone:916-715-7374
Mailing Address - Fax:
Practice Address - Street 1:2574 RALEIGH WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-6973
Practice Address - Country:US
Practice Address - Phone:916-715-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty