Provider Demographics
NPI:1548892276
Name:ALVARADO RADIOLOGY GROUP INC, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALVARADO RADIOLOGY GROUP INC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-455-4109
Mailing Address - Street 1:PO BOX 2039
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-2039
Mailing Address - Country:US
Mailing Address - Phone:877-845-6638
Mailing Address - Fax:
Practice Address - Street 1:13700 MARINA POINTE DR UNIT 430
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-9277
Practice Address - Country:US
Practice Address - Phone:858-546-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty