Provider Demographics
NPI:1730595984
Name:ADVANCED IMAGING OF TRACY LLC
Entity type:Organization
Organization Name:ADVANCED IMAGING OF TRACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PORZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-833-2393
Mailing Address - Street 1:PO BOX 398091
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-4016
Mailing Address - Country:US
Mailing Address - Phone:209-833-2393
Mailing Address - Fax:
Practice Address - Street 1:7208 LOTUS AVE
Practice Address - Street 2:APT 15
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91755-1255
Practice Address - Country:US
Practice Address - Phone:209-833-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty