Provider Demographics
NPI:1740236231
Name:VALLEY RADIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:VALLEY RADIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSWALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-947-4885
Mailing Address - Street 1:936 E FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-5683
Mailing Address - Country:US
Mailing Address - Phone:909-947-4885
Mailing Address - Fax:909-947-4886
Practice Address - Street 1:936 E FRANCIS ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-5683
Practice Address - Country:US
Practice Address - Phone:909-947-4885
Practice Address - Fax:909-947-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29988ZMedicare PIN