Provider Demographics
NPI:1790812253
Name:VALLEY IMAGING PARTNERSHIP-WEST COVINA PET LLC
Entity Type:Organization
Organization Name:VALLEY IMAGING PARTNERSHIP-WEST COVINA PET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-813-9988
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91793-0635
Mailing Address - Country:US
Mailing Address - Phone:626-338-8390
Mailing Address - Fax:626-962-4657
Practice Address - Street 1:1401 W MERCED AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3401
Practice Address - Country:US
Practice Address - Phone:626-338-8390
Practice Address - Fax:626-962-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFAC64156207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG586Medicare PIN
CACB204036Medicare PIN