Organization
REDWOOD RADIOLOGY IMAGING MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN LINDSAY VILTRAKIS M D (VICE PRESIDENT)
(707) 768-1988
Entity
Organization
Contact information
Practice address
3300 RENNER DR, FORTUNA, CA 95540-3120
(707) 725-3361
Mailing address
PO BOX 6640, EUREKA, CA 95502-6640
(707) 768-1988
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G72357
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0079730
—
CA
Enumeration date
09/01/2006
Last updated
08/22/2020
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