Basic Information
| Provider Information | |||||||||
| NPI: | 1578529756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOLANO IMAGING MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3222 | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945580293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072617804 | ||||||||
| FaxNumber: | 7072563508 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 B GALE WILSON BLVD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945333552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076465100 | ||||||||
| FaxNumber: | 7074297997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRONK | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7072617880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | GR0046111 | 05 | CA | MEDICAID | GR0046112 | 05 | CA | MEDICAID | GR0046110 | 05 | CA | MEDICAID | GR0046115 | 05 | CA | MEDICAID |