Organization
RENAISSANCE RADIOLOGY MED GRP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIKA L KIEF GARCIA (PRESIDENT CEO)
(909) 620-8180
Entity
Organization
Contact information
Practice address
2101 N WATERMAN AVE, SAN BERNARDINO, CA 92404-4836
(909) 620-8180
(909) 469-6741
Mailing address
1902 ROYALTY DRIVE, SUITE 220, POMONA, CA 91767
(909) 620-8180
(909) 469-6741
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
CA
2085R0204X
Vascular & Interventional Radiology Physician
—
CA
2085U0001X
Diagnostic Ultrasound Physician
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG1263
RAILROAD MEDICARE
CA
05
—
GR008539F
—
CA
Enumeration date
11/30/2005
Last updated
06/24/2008
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