Provider Demographics
NPI:1497764468
Name:CALIFORNIA IMAGING INSTITUTE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CALIFORNIA IMAGING INSTITUTE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESENDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-325-5800
Mailing Address - Street 1:1867 E FIR AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3841
Mailing Address - Country:US
Mailing Address - Phone:559-325-5800
Mailing Address - Fax:
Practice Address - Street 1:1867 E FIR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3841
Practice Address - Country:US
Practice Address - Phone:559-325-5800
Practice Address - Fax:559-325-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2807568261QM1300X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03565ZMedicare ID - Type UnspecifiedPROVIDER GROUP NUMBER