1477215226 NPI number — CALIFORNIA RADIOLOGY MANAGEMENT INC

Table of content: MR. TIMOTHY FRANK MATTIS PT (NPI 1336107945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477215226 NPI number — CALIFORNIA RADIOLOGY MANAGEMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA RADIOLOGY MANAGEMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1477215226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20011 VENTURA BLVD # 1002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364-2573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-708-6163
Provider Business Mailing Address Fax Number:
818-340-5537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1884 BUSINESS CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92408-3457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-890-5552
Provider Business Practice Location Address Fax Number:
909-890-5588
Provider Enumeration Date:
10/08/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALARI
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
818-708-6163

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)