Provider Demographics
NPI:1740622729
Name:DIAGNOSTIC ULTRASOUND IMAGING, LLC
Entity type:Organization
Organization Name:DIAGNOSTIC ULTRASOUND IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS,RDCS,RVT
Authorized Official - Phone:559-267-3266
Mailing Address - Street 1:4025 N FRESNO ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4027
Mailing Address - Country:US
Mailing Address - Phone:559-800-6159
Mailing Address - Fax:559-384-0500
Practice Address - Street 1:703 N FULTON ST
Practice Address - Street 2:202
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3405
Practice Address - Country:US
Practice Address - Phone:559-570-8324
Practice Address - Fax:559-384-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246X00000X, 2471S1302X, 2471V0105X
CA261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA142796Medicare PIN
CA1740622729Medicare NSC
CA6871237Medicaid
CAGF231ZOtherPTAN