Organization
CENTRAL VALLEY IMAGING MEDICAL ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD M PORZIO MD (PRESIDENT)
(209) 647-2184
Entity
Organization
Contact information
Practice address
250 CHERRY LN STE 116, MANTECA, CA 95337-4398
(209) 647-2184
Mailing address
PO BOX 398076, SAN FRANCISCO, CA 94139-8076
(209) 647-2184
(209) 647-4684
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
71935
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0092110
—
CA
05
—
GR0092111
—
CA
05
—
GR0092113
—
CA
05
—
GR0092114
—
CA
01
—
ZZZ05093Z
BLUE SHIELD
CA
01
—
ZZZ05094Z
BLUE SHIELD
CA
01
—
ZZZ08287Z
BLUE SHIELD
CA
01
—
ZZZ65959Z
BLUE SHIELD
CA
Enumeration date
10/24/2005
Last updated
07/10/2019
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