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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
550 N MONTEREY AVENUE, ONTARIO, CA 91764-3318
(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
2085U0001X
Diagnostic Ultrasound Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CG1263
RAILROAD MEDICARE
CA
05
GR008539G
CA
Enumeration date
06/10/2006
Last updated
06/24/2008
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