Organization
RCOA-ADVENTIST HEALTH, LLC
Active
Other names
Adventist Health PET/CT - Sonora
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRICK R MOORE (VP OF ACCOUNTING AND FINANCE)
(561) 477-3500
Entity
Organization
Contact information
Practice address
1000 GREENLEY RD, SONORA, CA 95370-5200
(866) 293-3500
(866) 293-3535
Mailing address
P. O. BOX 85001, ORLANDO, FL 32885-0001
(866) 293-3500
(866) 293-3535
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
6838-17
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ66592Z
BS OF CA PROVIDER NUMBER
CA
Enumeration date
05/18/2006
Last updated
08/22/2020
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