Provider Demographics
NPI:1568427904
Name:VALLEY METABOLIC IMAGING LLC
Entity Type:Organization
Organization Name:VALLEY METABOLIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-631-2221
Mailing Address - Street 1:11100 NE 8TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-635-4365
Mailing Address - Fax:425-637-7535
Practice Address - Street 1:6121 N THESTA AVE
Practice Address - Street 2:STE 207
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-449-2640
Practice Address - Fax:559-432-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1DTF261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1DTF00300Medicaid
CAZZZ23924ZMedicare ID - Type Unspecified