MODESTO RADIOLOGICAL MEDICAL GROUP (NPI# 1578937744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578937744 |
| Entity Type | Organization |
| Organization Name | MODESTO RADIOLOGICAL MEDICAL GROUP |
| Practice Address |
2283 Hidden Pond Ln Lafayette CA 94549-1742 |
| Mailing Address |
1524 Mchenry Ave Suite 430 Modesto CA 95350-4500 |
| Practice Telephone | 5594554009 |
| Practice Fax Number | 9165330023 |
| Mailing Telephone | 5594554009 |
| Mailing Fax Number | 9165330023 |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |
| Authorized Official Name | MARK MOORE (CFO/COO) |
| Authorized Official Telephone | 2093425946 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Street Address |
2283 HIDDEN POND LN |
| City | LAFAYETTE |
| State | CA |
| Zip Code | 94549-1742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427004 | Veronica Adelaid Valera-averilla | Behavior Technician | 3650 Mt Diablo Blvd. Ste. 107, Lafayette Ca Contra, CA 94549 | 2020-11-06 |
| 1679128870 | Zong Ning Zhou | Behavior Technician | 3650 Mt.diablo Blvd., Suite 107, Lafayette, CA 94549 | 2019-08-05 |
| 1912551227 | Tamiesha Jackson | Behavior Technician | Ste Consultant, LLC, 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2019-07-25 |
| 1528525375 | Tiara Lajai Aubrey | Behavior Technician | 3560 Mt. Diablo Blvd, Suite 107, Layfatte, CA 94549 | 2019-02-28 |
| 1215409990 | Marisa Della Marmolejo | Case Manager/Care Coordinator | Ste Consultants, LLC 3650 Mt Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-12-19 |
| 1235608399 | Andrew Thompson | Behavior Technician | 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2018-11-19 |
| 1982172953 | Amber Jackson | Behavior Technician | Ste, LLC, 3650 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-11-08 |
| 1104393396 | Alexis Taper | Behavior Technician | Ste Consultants LLC, 3650 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-10-26 |
| 1023508793 | Alyssa Savinovich | Behavior Technician | 3560 Mt. Diablo Blvd., Suite 107, Lafayette, CA 94549 | 2018-05-17 |
| 1831689140 | Kannambra M Raja | Behavior Technician | Ste Consultants LLC, 3650 Mt. Diablo Blvd, Suite 107, Lafayette, CA 94549 | 2018-05-11 |
| Find all providers in zip 94549 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588295448 | Hassan Sawaf | Radiology | 1411 S Creasy Ln Ste 130, Lafayette, IN 47905-7433 | 2020-01-30 |
| 1801383245 | St Marys Imaging Center II | Radiology | 4809 Ambassador Caffery Pkwy Ste 350, Lafayette, LA 70508-8801 | 2018-04-20 |
| 1629411210 | Lowell David Froker | Radiology | 32 Olympic Oaks Dr, Lafayette, CA 94549-4800 | 2013-04-12 |
| 1386987196 | Imaging Partners Medical Group | Radiology | 3976 Canyon Rd, Lafayette, CA 94549-2702 | 2013-03-29 |
| 1982946562 | Rachael Lane Guillory | Radiology | 1811 Dulles Dr, Lafayette, LA 70506-3724 | 2013-03-21 |
| 1578811386 | Maurice Louis Bercier | Radiology | 309 Steiner Road, Lafayette, LA 70508 | 2012-08-28 |
| 1295024222 | Lourdes Imaging Center LLC | Radiology | 4809 Ambassador Caffery Parkway, Suite 350, Lafayette, LA 70508 | 2011-03-30 |
| 1467784744 | Delano Zeus Arvin | Radiology | 6233 N 700 E, Lafayette, IN 47905-9761 | 2010-02-11 |
| 1003045287 | Professional Radiology Network Tlc-prn, LLC | Radiology | 107 Kempton Dr, Lafayette, LA 70508-6547 | 2009-07-08 |
| 1093942112 | Munesh Singh Kalsi | Radiology | 1701 S. Creasy Ln, Lafayette, IN 47905-4972 | 2009-06-16 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.