Provider Demographics
NPI:1316007537
Name:CITY IMAGING
Entity Type:Organization
Organization Name:CITY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-647-2163
Mailing Address - Street 1:2588 MISSION ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2592
Mailing Address - Country:US
Mailing Address - Phone:415-647-2163
Mailing Address - Fax:415-695-0673
Practice Address - Street 1:2588 MISSION ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2592
Practice Address - Country:US
Practice Address - Phone:415-647-2163
Practice Address - Fax:415-695-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24364111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0243640Medicaid
CADC0243640Medicaid