Basic Information
| Provider Information | |||||||||
| NPI: | 1821271727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA MANAGED IMAGING MEDICAL GROUP,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2320 BATH ST STE 208 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058797562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2320 BATH ST STE 208 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827744 | ||||||||
| FaxNumber: | 8056823321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2007 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | BLACK | ||||||||
| AuthorizedOfficialFirstName: | M | ||||||||
| AuthorizedOfficialMiddleName: | DEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8056827744 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.