Provider Demographics
NPI:1801271960
Name:RIVERWALK ULTRASOUND CENTER
Entity type:Organization
Organization Name:RIVERWALK ULTRASOUND CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLACRESES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-963-6286
Mailing Address - Street 1:4193 FLAT ROCK DR
Mailing Address - Street 2:SUITE 200-212
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-7111
Mailing Address - Country:US
Mailing Address - Phone:951-807-0386
Mailing Address - Fax:
Practice Address - Street 1:4193 FLAT ROCK DR
Practice Address - Street 2:SUITE 200-212
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7111
Practice Address - Country:US
Practice Address - Phone:951-807-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty