Peninsula Ultrasound, Mammography and Radiology Services Med Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

G46504 Issued in CA

Legal business name

PENINSULA ULTRASOUND, MAMMOGRAPHY AND RADIOLOGY SERVICES MED GROUP INC

Doing business as

Peninsula Diagnostic Imaging Inc

Practice address

101 S San Mateo Dr
Suite 201
San Mateo, CA 94401-3819

Phone

(650) 343-1655

Fax

(650) 343-1686

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Beth Kleiner, M.D

Title

Ceo

Phone

(650) 343-1655

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Peninsula Diagnostic Imaging Inc Doing business as

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1619066511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S SAN MATEO DR",
            "address_2": "SUITE 201",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013819",
            "telephone_number": "650-343-1655",
            "fax_number": "650-343-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S SAN MATEO DR",
            "address_2": "SUITE 201",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013819",
            "telephone_number": "650-343-1655",
            "fax_number": "650-343-1686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA ULTRASOUND, MAMMOGRAPHY AND RADIOLOGY SERVICES MED GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "KLEINER",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-343-1655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G46504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NLAI NPI",
            "identifier": "1932326188",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SM NPI",
            "identifier": "1801835079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BK NPI",
            "identifier": "1396878435",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MPASTO NPI",
            "identifier": "1841297272",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peninsula Diagnostic Imaging Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; 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.