RENAISSANCE RADIOLOGY MEDICAL GROUP, INC. (NPI# 1932104908) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932104908 |
| Entity Type | Organization |
| Organization Name | RENAISSANCE RADIOLOGY MEDICAL GROUP, INC. |
| Practice Address |
16850 Bear Valley Rd Victorville CA 92395-5794 |
| Mailing Address |
1902 Royalty Dr Ste 220 Pomona CA 91767-3056 |
| Practice Telephone | 7602418000 |
| Mailing Telephone | 9096208180 |
| Mailing Fax Number | 9094696741 |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2008-06-24 |
| Authorized Official Name | DR. MONIKA KIEF GARCIA (PRESIDENT CEO) |
| Authorized Official Telephone | 9096208180 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
FNP26150 | CA | Allopathic & Osteopathic Physicians |
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
FNP26150 | CA | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
FNP26150 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RAILROAD MEDICARE | CG1263 | 01 |
| CA | GR008539K | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821019472 | Renaissance Radiology Medical Group, Inc. | Radiology | 5470 Jefferson Ave, Chino, CA 91710-3517 | 2006-07-21 |
| 1598749921 | Renaissance Radiology Medical Group, Inc. | Radiology | 5000 San Bernardino St, Montclair, CA 91763-2326 | 2005-11-30 |
| 1437154697 | Renaissance Radiology Medical Group, Inc. | Radiology | 9041 Magnolia Ave, Ste 101, Riverside, CA 92503-3900 | 2005-06-15 |
| 1952306136 | Renaissance Radiology Medical Group, Inc. | Radiology | 1805 Medical Center Dr, San Bernardino, CA 92411-1217 | 2005-06-15 |
| 1316107550 | Renaissance Radiology Medical Group, Inc. | Radiology | 2000 Stadium Way, Los Angeles, CA 90026-2606 | 2008-06-11 |
| 1568668739 | Renaissance Radiology Medical Group, Inc. | Clinic/Center | 5470 Jefferson Ave, Chino, CA 91710-3517 | 2007-06-25 |
| 1134200983 | Renaissance Radiology Medical Group, Inc. | Radiology | 8599 Haven Ave., Suite 300, Rancho Cucamonga, CA 91730-4849 | 2006-10-18 |
| 1023092541 | Renaissance Radiology Medical Group, Inc. | Radiology | 3865 Jackson St, Riverside, CA 92503-3919 | 2005-11-30 |
| 1801870233 | Renaissance Radiology Medical Group, Inc. | Radiology | 26520 Cactus Ave, Moreno Valley, CA 92555-3927 | 2005-11-30 |
| Street Address |
16850 BEAR VALLEY RD |
| City | VICTORVILLE |
| State | CA |
| Zip Code | 92395-5794 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780216853 | Hieu Trung Huynh | Pharmacist | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2020-02-06 |
| 1801428107 | Stephanie Victoria Ingrassia | Nurse Practitioner | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2020-02-05 |
| 1831737188 | Jannet Cardin | Pharmacist | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2019-12-18 |
| 1265070684 | Regina Renee Cendejas | Nurse Practitioner | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2019-12-16 |
| 1013568526 | Krystle Ann Frazier | Nurse Practitioner | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2019-09-25 |
| 1265088116 | Stephany Salazar | Clinic/Center | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2019-08-16 |
| 1346893054 | Junel Buenafe Tagayuna | Pharmacist | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2019-07-22 |
| 1942865381 | Duvan Martinez | Nurse Practitioner | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2019-05-01 |
| 1568925378 | Nicole Marie Sweeney | Speech-Language Pathologist | 16850 Bear Valley Rd, Victorville, CA 92395-5795 | 2019-04-09 |
| 1407314552 | Kelsey Sandoval | Physician Assistant | 16850 Bear Valley Rd, Victorville, CA 92395-5794 | 2019-03-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837966 | Desert Ridge Transitional Care Center, Lp | Skilled Nursing Facility | 13300 11th Avenue, Victorville, CA 92395 | 2020-06-26 |
| 1376179093 | Catherine Ward | Speech-Language Pathologist | 13275 Mauka Ct, Victorville, CA 92395 | 2020-03-13 |
| 1174019228 | Laura Mercado Halterman | Family Medicine | 16519 Victor St Ste 307, Victorville, CA 92395 | 2018-07-02 |
| 1306337829 | Stephanie Ann Kruger | Behavior Technician | Sunny Days Inc 3602 Inland Empire Blvd., Ontario, CA 92395 | 2018-05-21 |
| 1861903924 | Debra L Andersen | Clinic/Center | 12830 Hesperia Road, Suite C, D, E, Victorville, CALIFORNIA 92395 | 2017-10-17 |
| 1790202141 | Joshua Powers | Physician Assistant | 12550 Hesperia Rd Ste 101, Victorville, CA 92395 | 2017-08-26 |
| 1043759491 | Kemp Individual & Family Therapy, Inc. | Marriage & Family Therapist | 14075 Hesperia Road, Suite 101, Victorville, CA 92395 | 2017-02-17 |
| 1740725969 | Abem Transportation Inc | Non-emergency Medical Transport (VAN) | 15000 7th St Ste F208, Victorville, CA 92395 | 2016-12-23 |
| 1447669379 | Tracie Girard | Nurse Practitioner | 17330 Bear Valley Road, Suite A106, Victorville, CA 92395 | 2014-08-05 |
| 1093153215 | Mitesh Patel | Surgery | 13010 Hesperia Rd Ste 400, Victorville, CA 92395 | 2013-06-10 |
| Find all providers in zip 92395 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114208113 | John Joseph Cerrone | Radiology | 17891 San Gabriel Lane, 7816 Svl Box, Victorville, CA 92395 | 2011-09-02 |
| 1497941264 | Victor Valley Advanced Imaging | Radiology | 15247 Eleventh St, Suite 700, Victorville, CA 92395-3727 | 2007-09-14 |
| 1467647636 | Beverly Radiology Medical Group IIi Dba Victor Valley Advanced Imaging | Radiology | 12677 Hesperia Rd Ste 190, Victorville, CA 92395-7754 | 2007-09-11 |
| 1679574594 | Riverside Radiology Medical Group Inc | Radiology | 12276 Hesperia Rd, Ste 6, Victorville, CA 92395-5838 | 2005-08-02 |
| 1386909356 | Mary Maunglay | Radiology | 12602 Amargosa Rd, Victorville, CA 92392-7640 | 2012-07-05 |
| 1740507342 | Rahul Nayyar | Radiology | 15248 11th St, Victorville, CA 92395-3704 | 2010-04-23 |
| 1497941421 | Beverly Radiology Medical Group IIi Dba Victor Valley Advanced Imaging | Radiology | 12276 Hesperia Rd Ste 6, Victorville, CA 92395-5838 | 2007-09-24 |
| 1114112372 | Beverly Radiology Medical Group IIi | Radiology | 17260 Bear Valley Rd, Suite 109, Victorville, CA 92395-7777 | 2007-09-11 |
| 1114063294 | Glenn P. Wedeen Md A Medical Corporation | Radiology | 15248 11th St, Victorville, CA 92395-3704 | 2007-01-29 |
| 1275577504 | Glenn P. Wedeen | Radiology | 15248 11th St, Victorville, CA 92395-3704 | 2006-06-16 |
| Find all providers in VICTORVILLE | ||||
| City | VICTORVILLE |
| Zip Code | 92395 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.