Organization
RENAISSANCE RADIOLOGY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA S. KAUFMAN (BILLING MANAGER)
(909) 570-3108
Entity
Organization
Contact information
Practice address
2224 MEDICAL CENTER DR, PERRIS, CA 92571-2638
(909) 570-3108
Mailing address
1902 ROYALTY DR, SUITE 220, POMONA, CA 91767-3030
(909) 570-3108
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ05740Z
MEDICARE PTAN
CA
Enumeration date
07/10/2007
Last updated
10/09/2008
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