Renaissance Radiology Med GRP Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

RENAISSANCE RADIOLOGY MED GRP INC

Practice address

2101 N Waterman Ave
San Bernardino, CA 92404-4836

Phone

(909) 620-8180

Fax

(909) 469-6741

NPI assigned

Nov 30, 2005

Reactivated

Oct 11, 2007

Organization subpart

No

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

Authorized official

Name

Monika L Kief Garcia

Title

President Ceo

Phone

(909) 620-8180

Specialties & licenses 3

Addresses

Other identifiers 2

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1225012644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 ROYALTY DRIVE",
            "address_2": "SUITE 220",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "91767",
            "telephone_number": "909-620-8180",
            "fax_number": "909-469-6741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044836",
            "telephone_number": "909-620-8180",
            "fax_number": "909-469-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE RADIOLOGY MED GRP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-30",
        "last_updated": "2008-06-24",
        "deactivation_date": "2007-08-28",
        "reactivation_date": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "KIEF GARCIA",
        "authorized_official_first_name": "MONIKA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "909-620-8180"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR008539F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG1263",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Michelle Reimann, R.D.H.
• Sandra Michelle Reliford
• Jade Remillard
• Sana Remillard, NO
• Donita Lynn Remington
• Renaissance Radiology Medical Group, Inc
• Renaissance Radiology Medical Group, Inc.
• Renal Treatment Centers California Inc
• Renal Treatment Centers California Inc
• Renewed Impressions of Life LLC

• Diagnostic Radiology Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.