Provider Demographics
NPI:1134167513
Name:CITRUS VALLEY IMAGING, INC
Entity type:Organization
Organization Name:CITRUS VALLEY IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CITRUS VALLEY IMAGING
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-478-5160
Mailing Address - Street 1:PO BOX 7008
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0008
Mailing Address - Country:US
Mailing Address - Phone:909-478-5160
Mailing Address - Fax:909-335-8217
Practice Address - Street 1:350 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4850
Practice Address - Country:US
Practice Address - Phone:909-478-5160
Practice Address - Fax:909-335-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00375MMedicare ID - Type Unspecified