Provider Demographics
NPI:1922391747
Name:WILLIAM L MASSIE
Entity Type:Organization
Organization Name:WILLIAM L MASSIE
Other - Org Name:ADVANCED DIAGNOSTIC ULTRASOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-929-7600
Mailing Address - Street 1:1600 E FLORIDA AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8639
Mailing Address - Country:US
Mailing Address - Phone:951-929-7600
Mailing Address - Fax:951-750-5089
Practice Address - Street 1:1600 E FLORIDA AVE STE 315
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8639
Practice Address - Country:US
Practice Address - Phone:951-929-7600
Practice Address - Fax:951-750-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107682471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10768OtherSONOGRAPHER LICENSE NUMBER