Organization
SAN GABRIEL VIP A CALIFORNIA LIMITED PARTNERSHIP
Active
Other names
Valley Imaging Partnership
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD D. KAISERMAN M.D. (MEDICAL DIRECTOR)
(626) 813-9988
Entity
Organization
Contact information
Practice address
1115 S SUNSET AVE, WEST COVINA, CA 91790-3940
(626) 813-9988
(626) 813-0075
Mailing address
PO BOX 635, WEST COVINA, CA 91793-0635
(626) 813-9988
(626) 813-0075
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCBS
ZZZ25286Z
CA
01
—
CQ2233
MEDICARE RR
CA
05
—
GR0058270
—
CA
Enumeration date
06/10/2006
Last updated
06/17/2013
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