Basic Information
| Provider Information | |||||||||
| NPI: | 1679516785 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA ADVANCED IMAGING MEDICAL ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6102 | ||||||||
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| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949486102 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 ALAMEDA DE LAS PULGAS | ||||||||
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| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940622799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503675536 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 10/10/2013 | ||||||||
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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 | GR000314I | 05 | CA | MEDICAID | CI2439 | 01 | CA | RAILROAD MEDICARE | OTHER |