Basic Information
| Provider Information | |||||||||
| NPI: | 1457306839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA ADVANCED IMAGING MEDICAL ASSOC., INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAIMA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6102 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949486102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158843415 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CASTRO & DUBOCE | ||||||||
| Address2: | NORTH TOWER, LEVEL A | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156006180 | ||||||||
| FaxNumber: | 4154369160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | HOYE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 4158843404 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/23/2021 | ||||||||
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 | GR000314S | 05 | CA | MEDICAID |