Basic Information
| Provider Information | |||||||||
| NPI: | 1447204920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA ADVANCED IMAGING MEDICAL ASSOCOATES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 REDWOOD BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949476922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158843415 | ||||||||
| FaxNumber: | 4158830877 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 SIR FRANCIS DRAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | KENTFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949041418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154569680 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 02/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | BELICK | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 4158843096 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CI2439 | 01 | CA | RAILROAD MEDICARE | OTHER | GR00314B | 05 | CA | MEDICAID |