Provider Demographics
NPI:1144338757
Name:RIVAS-SMITH IMAGING
Entity type:Organization
Organization Name:RIVAS-SMITH IMAGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-562-7172
Mailing Address - Street 1:833 SEQUOIA AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1424
Mailing Address - Country:US
Mailing Address - Phone:559-562-7172
Mailing Address - Fax:559-562-7174
Practice Address - Street 1:833 SEQUOIA AVE
Practice Address - Street 2:STE. B
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1424
Practice Address - Country:US
Practice Address - Phone:559-562-7172
Practice Address - Fax:559-562-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00441091OtherRAILROAD MEDICARE
CA00A370431Medicaid
CAZZZ16003ZMedicare PIN