Provider Demographics
NPI:1922642370
Name:FRONTLINE ULTRASOUND
Entity Type:Organization
Organization Name:FRONTLINE ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARNELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS,RVT
Authorized Official - Phone:510-816-0741
Mailing Address - Street 1:1720 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5317
Mailing Address - Country:US
Mailing Address - Phone:510-816-0741
Mailing Address - Fax:
Practice Address - Street 1:1720 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5317
Practice Address - Country:US
Practice Address - Phone:510-816-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile