Organization
MODESTO ADVANCED DIAGNOSTIC IMAGING MEDICAL CENTER
Active
Other names
MODESTO ADVANCED DIAG IMAGING MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD G BERGER MD (PRESIDENT)
(310) 445-2800
Entity
Organization
Contact information
Practice address
157 E COOLIDGE AVE, MODESTO, CA 95350-4504
(209) 524-6800
(209) 524-1286
Mailing address
1516 COTNER AVE, LOS ANGELES, CA 90025-3303
(310) 445-2951
(310) 479-1459
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0047560
—
CA
01
—
ZZZ01347Z
BLUE SHIELD
CA
Enumeration date
05/20/2006
Last updated
12/29/2016
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