MEDICARE: ST JUDE RADIOLOGY MEDICAL GRP, INC

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	2085R0202X	Diagnostic Radiology Physician		CA

General Provider Information

NPI Number	:	1588788152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JUDE RADIOLOGY MEDICAL GRP, INC

Provider Business Mailing Address
First Line	:	PO BOX 4505
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91365-4505
Country	:	US
Telephone Number	:	805-375-8800
Fax Number	:	805-375-8900

Provider Business Practice Location Address
First Line	:	2151 N HARBOR BLVD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3801
Country	:	US
Telephone Number	:	714-992-3978
Fax Number	:	714-992-3298

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT C MORTEN
Credential	:	M.D.
Telephone Number	:	714-992-3978

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1295721900 — BING-LO CHANG M.D.
Practice Location Address:

2151 N HARBOR BLVD , SUITE 3200
FULLERTON, CA
92835-3801

Practice Phone: 714-446-5101
Practice Fax: 714-871-3006

1407843949 — JAMES L BENOIT M.D.
Practice Location Address:

2151 N HARBOR BLVD , SUITE 3200
FULLERTON, CA
92835-3801

Practice Phone: 714-446-5101
Practice Fax: 714-871-3006

1063501997 — ALAN BORSARI M.D.
Practice Location Address:

2151 N HARBOR BLVD
FULLERTON, CA
92835-3801

Practice Phone: 714-449-4800
Practice Fax: 714-449-4956

1174609358 — SANJAY SHARMA M.D.
Practice Location Address:

2151 N HARBOR BLVD , SUITE 2200
FULLERTON, CA
92835-3801

Practice Phone: 714-449-4800
Practice Fax: 714-449-4956

1275619447 — DAVID J PARK M.D.
Practice Location Address:

2151 N HARBOR BLVD , SUITE 2200
FULLERTON, CA
92835-3801

Practice Phone: 714-446-5900
Practice Fax: 714-446-5800

1336347855 — DR. PHILIP MARTIN MOLINA DPT
Practice Location Address:

2151 N HARBOR BLVD , SUITE 3100
FULLERTON, CA
92835-3801

Practice Phone: 714-992-3000
Practice Fax: 714-447-6534

Directions to “ST JUDE RADIOLOGY MEDICAL GRP, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.