Organization
RENAISSANCE IMAGING MEDICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN VAUGHN (AO)
(629) 317-1465
Entity
Organization
Contact information
Practice address
18436 ROSCOE BLVD, NORTHRIDGE, CA 91325-4107
(818) 435-1400
Mailing address
PO BOX 85491, CHICAGO, IL 60689-5491
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG2517
RAILROAD MEDICARE
—
05
—
GR0086070
—
CA
05
—
GR0086071
—
CA
01
—
ZZZ33823Z
BLUE SHIELD
—
01
—
ZZZ59788Z
BLUE SHIELD
—
01
—
ZZZ65767Z
BLUE SHIELD
—
01
—
ZZZ65816Z
BLUE SHIELD
—
01
—
ZZZ67806Z
BLUE SHIELD
—
01
—
ZZZ69508Z
BLUE SHIELD
—
Enumeration date
05/20/2006
Last updated
03/25/2026
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