Provider Demographics
NPI:1467993386
Name:I V RADIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:I V RADIOLOGY MEDICAL GROUP
Other - Org Name:IMPERIAL VALLEY RADIOLOGY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:O
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-455-4009
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-0009
Mailing Address - Country:US
Mailing Address - Phone:559-455-4009
Mailing Address - Fax:916-533-0313
Practice Address - Street 1:10000 TOWN CENTER AVE
Practice Address - Street 2:APT 244
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-5418
Practice Address - Country:US
Practice Address - Phone:559-455-4009
Practice Address - Fax:916-533-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty