MEDICARE: RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154302651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1500 EXPO PKWY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4227
Country	:	US
Telephone Number	:	916-646-8406
Fax Number	:	916-920-4434

Provider Business Practice Location Address
First Line	:	2 MEDICAL PLAZA DR
Second Line	:	SUITE 180
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3043
Country	:	US
Telephone Number	:	916-781-1221
Fax Number	:	916-797-4799

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JONATHAN BRESLAU
Credential	:	M.D.
Telephone Number	:	916-646-8300

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	10/27/2011

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