Basic Information
| Provider Information | |||||||||
| NPI: | 1598717613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEL NORTE MEDICAL IMAGING, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 J ST | ||||||||
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| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955011922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074430424 | ||||||||
| FaxNumber: | 7074430404 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955318359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074648511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 01/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | VOLLGER | ||||||||
| AuthorizedOfficialFirstName: | HELMUTH | ||||||||
| AuthorizedOfficialMiddleName: | FRANK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7074430424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 |
No ID Information.