Provider Demographics
NPI:1881787448
Name:CALIFORNIA IMAGING AND TREATMENT CENTER LLC
Entity type:Organization
Organization Name:CALIFORNIA IMAGING AND TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-465-8400
Mailing Address - Street 1:3000 OAK ROAD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597
Mailing Address - Country:US
Mailing Address - Phone:925-465-8400
Mailing Address - Fax:925-465-8410
Practice Address - Street 1:3000 OAK ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597
Practice Address - Country:US
Practice Address - Phone:925-465-8400
Practice Address - Fax:925-465-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27175ZMedicare ID - Type Unspecified