Organization
INTERMED IMAGING A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER PRESTON MAYNARD M.D. (PRESIDENT/RADIOLOGIST)
(310) 671-9754
Entity
Organization
Contact information
Practice address
880 E TUOLUMNE RD, TURLOCK, CA 95382-1548
(310) 671-9754
(310) 671-3916
Mailing address
125 N PRAIRIE AVE, INGLEWOOD, CA 90301-1904
(310) 671-9754
(310) 671-3916
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
C33935
CA
2085N0700X
Neuroradiology Physician
C33935
CA
2085N0904X
Nuclear Radiology Physician
C33935
CA
2085P0229X
Pediatric Radiology Physician
C33935
CA
2085R0202X
Diagnostic Radiology Physician
Primary
C33935
CA
2085R0203X
Therapeutic Radiology Physician
C33935
CA
2085R0204X
Vascular & Interventional Radiology Physician
C33935
CA
2085U0001X
Diagnostic Ultrasound Physician
C33935
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C339350
MEDICAID NO CA
CA
01
—
00C339353
MEDICARE NO CA
CA
01
—
C33935
MEDICAL LICENSE
CA
Enumeration date
01/24/2011
Last updated
03/07/2023
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