Organization
DIAGNOSTIC IMAGING MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN SONNABEND MD (CFO/PARTNER)
(805) 739-3412
Entity
Organization
Contact information
Practice address
1400 E CHURCH ST, SANTA MARIA, CA 93454-5906
(805) 739-3400
Mailing address
PO BOX 17886, RENO, NV 89511-1033
(805) 434-4989
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417089962
—
CA
05
—
GR0011720
—
CA
05
—
GR0011721
—
CA
01
—
ZZZ18870Z
BLUE SHIELD
CA
Enumeration date
03/11/2007
Last updated
07/26/2018
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