Organization
PALM IMAGING INSTITUTE, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TANIE DONALDSON RN (OFFICE MANAGER)
(909) 882-2266
Entity
Organization
Contact information
Practice address
399 E 21ST ST, SAN BERNARDINO, CA 92404-4815
(909) 882-2266
(909) 881-7593
Mailing address
399 E 21ST ST, SAN BERNARDINO, CA 92404-4815
(909) 882-2266
(909) 881-7593
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
G55682
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
A84930
CA
2085R0202X
Diagnostic Radiology Physician
Primary
28926
CA
225100000X
Physical Therapist
PT 10673
CA
363AS0400X
Surgical Physician Assistant
PA20947
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0063970
—
CA
Enumeration date
07/18/2005
Last updated
04/23/2018
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