Basic Information
| Provider Information | |||||||||
| NPI: | 1912348749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CITRUS VALLEY RADIOLOGISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5110 E CLINTON WAY | ||||||||
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| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937272040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594554053 | ||||||||
| FaxNumber: | 7706669102 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 S SUNSET AVE | ||||||||
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| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917903940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269624011 | ||||||||
| FaxNumber: | 6269520271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2013 | ||||||||
| LastUpdateDate: | 07/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | CEFALA | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 6269624011 | ||||||||
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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 | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.