Organization
PRONET IMAGING MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN V. CRUES III MD (PRESIDENT)
(310) 445-2800
Entity
Organization
Contact information
Practice address
1516 COTNER AVE, LOS ANGELES, CA 90025-3303
(310) 445-2800
(310) 445-2816
Mailing address
1516 COTNER AVE, LOS ANGELES, CA 90025-3303
(310) 445-2800
(310) 445-2816
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0101600
—
CA
01
—
ZZZ53357Z
BLUE SHIELD
CA
Enumeration date
07/06/2006
Last updated
01/24/2012
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