Provider Demographics
NPI:1922187541
Name:MONTEREY BAY IMAGING CENTER
Entity Type:Organization
Organization Name:MONTEREY BAY IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-722-2434
Mailing Address - Street 1:160 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3160
Mailing Address - Country:US
Mailing Address - Phone:831-722-2434
Mailing Address - Fax:831-722-6032
Practice Address - Street 1:160 GREEN VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3160
Practice Address - Country:US
Practice Address - Phone:831-722-2434
Practice Address - Fax:831-722-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75256 MED DIRECTOR261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31840ZMedicare ID - Type Unspecified