Pacific Radiology Inc a Professional Corporation

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 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

Last updated

Aug 23, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Vincent V. Lizama, M.D.NPI 1417918764

Title

President

Phone

(671) 777-5259

Specialties & licenses 1

Addresses

Other names 1

• Pacific Radiology Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in GU

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vincent Victor Lizama, M.D.

  • Radiography Radiologic Technologist
  • Tamuning, GU
  • NPI 1417918764
  Medicare reassignment Care Compare group Authorized official
• Michael Edwin Fenton, MD

  • Diagnostic Radiology Physician
  • Tamuning, GU
  • NPI 1033183264
  Medicare reassignment Care Compare group
• Matthew Boles, DO

  • Diagnostic Radiology Physician
  • Fort Worth, TX
  • NPI 1730573056

  GU

  Medicare reassignment NPD
• George G Bocobo, MD

  • Diagnostic Radiology Physician
  • West Chester, PA
  • NPI 1760428221

  GU

  Medicare reassignment
• David Michael Mudd, M.D.

  • Radiography Radiologic Technologist
  • Tamuning, GU
  • NPI 1134180409
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534982400000",
    "number": "1023230752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 TAKANO LN STE 302",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969134148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 YPAO RD",
            "address_2": "SDA RADIOLOGY DEPARTMENT",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133701",
            "telephone_number": "671-646-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC RADIOLOGY INC A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2018-08-23",
        "status": "A",
        "authorized_official_last_name": "LIZAMA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "671-777-5259",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Radiology Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Faraz Ouhadi, M.D.
• Pacific Cardiology Consultants LLC
• Pacific Echocardio Laboratory Services Inc
• Pacific Hand Surgery Center
• Pacific Pulmonology Consultants
• Pacific Urology Consultants LLC
• Xavier Rajesh Packianathan, MD
• Gemma Paguio, RN
• Karen Therese Evangelista Palomo
• Archaellus John Dela Vega Pamintuan

• Diagnostic Radiology Physician in Tamuning, GU
• Providers in Tamuning, GU by specialty
• Diagnostic Radiology Physician in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.