Basic Information
| Provider Information | |||||||||
| NPI: | 1699707174 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OASIS RADIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT LA 21607 | ||||||||
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| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911851607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492638620 | ||||||||
| FaxNumber: | 9492631639 | ||||||||
| Practice Location | |||||||||
| Address1: | 47-111 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922016739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607758066 | ||||||||
| FaxNumber: | 7607758181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | CORD | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7607758066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | ZZZ65381Z | 01 | CA | BS | OTHER | GR0101543 | 05 | CA | MEDICAID | ZZZ67699Z | 01 | CA | BLUE SHIELD | OTHER | GR0101544 | 05 | CA | MEDICAID | ZZZ67698Z | 01 | CA | BLUE SHIELD | OTHER | GR0101540 | 05 | CA | MEDICAID | GR0101542 | 05 | CA | MEDICAID | GR0101541 | 05 | CA | MEDICAID | ZZZ67697Z | 01 | CA | BLUE SHIELD | OTHER | ZZZ67700Z | 01 | CA | BLUE SHIELD | OTHER |