Provider Demographics
NPI:1912950676
Name:CALIFORNIA PACIFIC ADVANCED IMAGING
Entity type:Organization
Organization Name:CALIFORNIA PACIFIC ADVANCED IMAGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:153-084-8904
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-9125
Mailing Address - Fax:
Practice Address - Street 1:2351 CLAY ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1931
Practice Address - Country:US
Practice Address - Phone:415-600-3143
Practice Address - Fax:415-600-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA2436OtherRAILROAD MEDICARE
CAGR000314TMedicaid
CAZZZ25206ZMedicare PIN