Provider Demographics
NPI:1790189389
Name:ON-LINE RADIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ON-LINE RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-786-0801
Mailing Address - Street 1:1770 IOWA AVE
Mailing Address - Street 2:280
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2430
Mailing Address - Country:US
Mailing Address - Phone:951-786-0801
Mailing Address - Fax:877-892-0278
Practice Address - Street 1:28062 BAXTER RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1401
Practice Address - Country:US
Practice Address - Phone:559-455-4068
Practice Address - Fax:770-666-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty