Provider Demographics
NPI:1457396947
Name:SAN ANTONIO RADIOLOGICAL MEDICAL
Entity Type:Organization
Organization Name:SAN ANTONIO RADIOLOGICAL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMBRUOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-456-1250
Mailing Address - Street 1:9320 BASELINE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5829
Mailing Address - Country:US
Mailing Address - Phone:909-466-4231
Mailing Address - Fax:909-456-1255
Practice Address - Street 1:999 SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4920
Practice Address - Country:US
Practice Address - Phone:909-466-4231
Practice Address - Fax:909-456-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0014700Medicaid
CAGR0014700Medicaid
ZZZ93181ZMedicare ID - Type Unspecified