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Organization
VINE IMAGING PARTNERS MEDICAL GROUP, INC.
Active
Organization
VINE IMAGING PARTNERS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT WILLIAM ROGERO (PRESIDENT)
(209) 339-7476
Entity
Organization
Contact information
Practice address
1031 S FAIRMONT AVE, LODI, CA 95240-5112
(209) 334-8580
Mailing address
1031 S FAIRMONT AVE, LODI, CA 95240-5112
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/17/2021
Last updated
05/17/2021
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