Provider Demographics
NPI:1538389234
Name:MODESTO ADVANCED DIAGNOSTIC IMAGING MEDICAL CENTER
Entity type:Organization
Organization Name:MODESTO ADVANCED DIAGNOSTIC IMAGING MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-2800
Mailing Address - Street 1:1516 COTNER AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-445-2800
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1108 WARD AVENUE, BUILDING A
Practice Address - Street 2:SUITE 1
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363
Practice Address - Country:US
Practice Address - Phone:209-892-9100
Practice Address - Fax:209-892-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty