Pacific Radiology Inc a Professional Corporation
Organization Active NPI Diagnostic Radiology Physician · Tamuning, GU
NPI 1023230752 · NPPES record last updated Aug 23, 2018
Key facts
- NPI
- 1023230752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- PACIFIC RADIOLOGY INC A PROFESSIONAL CORPORATION
- Practice address
- 388 Ypao Rd
Sda Radiology Department
Tamuning, GU 96913-3701 - Phone
- (671) 646-8881
- NPI assigned
- May 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Vincent V. Lizama, M.D.
- Title
- President
- Phone
- (671) 777-5259
Practitioners 5
-
Vincent Victor Lizama, M.D.
-
Matthew Boles, DO
-
George G Bocobo, MD
-
David Michael Mudd, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GU
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181023003439 | GU | Part B Supplier - Clinic/Group Practice | 9830161546 |
Receives reassigned benefits from 4 practitioners Practice locations: Tamuning, GU |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
388 Ypao Rd
Sda Radiology Department
Tamuning, GU 96913-3701
Mailing address
121 Takano LN Ste 302
Tamuning, GU 96913-4148
Other names
- Pacific Radiology Inc
Other providers in Tamuning, GU
- Faraz Ouhadi
- Pacific Cardiology Consultants LLC
- Pacific Echocardio Laboratory Services Inc
- Pacific Hand Surgery Center
- Pacific Pulmonology Consultants
- Pacific Urology Consultants LLC
- Xavier Rajesh Packianathan
- Gemma Paguio
- Karen Therese Evangelista Palomo
- Archaellus John Dela Vega Pamintuan
All providers in Tamuning, GU · Diagnostic Radiology Physician in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.