Provider Demographics
NPI:1861441628
Name:COAST RADIOLOGY AND MEDICAL IMAGING
Entity Type:Organization
Organization Name:COAST RADIOLOGY AND MEDICAL IMAGING
Other - Org Name:COAST RADIOLOGY AND MEDICAL IMAGING MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:VALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-437-3833
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-437-3833
Mailing Address - Fax:562-624-0741
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-437-3833
Practice Address - Fax:562-624-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0017223Medicaid
CAGR0017222Medicaid
CAGR0017223Medicaid
CAHW8412AMedicare PIN
CAHW8412BMedicare PIN
CAGR0017222Medicaid
CAHW8412Medicare PIN