Provider Demographics
NPI:1558473975
Name:ADVANCED DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-473-9290
Mailing Address - Street 1:PO BOX 26750
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6750
Mailing Address - Country:US
Mailing Address - Phone:559-455-4024
Mailing Address - Fax:559-455-4007
Practice Address - Street 1:1441 E LELAND RD
Practice Address - Street 2:SUITE D & E
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5100
Practice Address - Country:US
Practice Address - Phone:925-473-9290
Practice Address - Fax:925-473-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty