Active NPI
Renaissance Radiology Med GRP Inc
- Diagnostic Radiology Physician
- Ontario, CA
National Provider Identifier
1316988256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- RENAISSANCE RADIOLOGY MED GRP INC
- Practice address
- 550 N Monterey Avenue
Ontario, CA 91764-3318 - Phone
- (909) 620-8180
- Fax
- (909) 469-6741
- NPI assigned
- Jun 10, 2006
- Reactivated
- Oct 11, 2007
- Organization subpart
- No
NPPES NPI Registry
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary | ||
| Diagnostic Ultrasound Physician | 2085U0001X |
Addresses
Primary practice location
550 N Monterey Avenue
Ontario, CA 91764-3318
Mailing address
1902 Royalty Drive
Suite 220
Pomona, CA 91767
Phone (909) 620-8180
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR008539G | Medicaid | CA | |
| CG1263 | Other | CA | RAILROAD MEDICARE |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1214265600000",
"number": "1316988256",
"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": "550 N MONTEREY AVENUE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917643318",
"telephone_number": "909-620-8180",
"fax_number": "909-469-6741"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RENAISSANCE RADIOLOGY MED GRP INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-10",
"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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
},
{
"code": "2085U0001X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Ultrasound",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR008539G",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CG1263",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- 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.