Provider Demographics
NPI:1942592837
Name:CASTRO VALLEY OPEN MRI MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CASTRO VALLEY OPEN MRI MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABELES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-538-1868
Mailing Address - Street 1:21030 REDWOOD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5920
Mailing Address - Country:US
Mailing Address - Phone:510-856-4800
Mailing Address - Fax:510-259-9103
Practice Address - Street 1:21030 REDWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5920
Practice Address - Country:US
Practice Address - Phone:510-856-4800
Practice Address - Fax:510-259-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3357822261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)