Provider Demographics
NPI:1568416147
Name:DESERT ADVANCED IMAGING MEDICAL CENTER
Entity Type:Organization
Organization Name:DESERT ADVANCED IMAGING MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-2800
Mailing Address - Street 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:72855 FRED WARING DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9368
Practice Address - Country:US
Practice Address - Phone:760-346-1130
Practice Address - Fax:760-836-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092473Medicaid
CAZZZ01739ZOtherBLUE SHIELD
CAZZZ01738ZOtherBLUE SHIELD
CAGR0092472Medicaid
CAZZZ01734ZOtherBLUE SHIELD
CAZZZ01736ZOtherBLUE SHIELD
CAZZZ01737ZOtherBLUE SHIELD
CAGR0092471Medicaid
CAZZZ01735ZOtherBLUE SHIELD
CAGR0092470Medicaid
CAGR0092474Medicaid
CAGR0092473Medicaid
CAZZZ21622ZMedicare PIN
CAZZZ01736ZOtherBLUE SHIELD
CAGR0092471Medicaid
CAZZZ21618ZMedicare PIN