MEDICARE: SOUTH COAST NUCLEAR MEDICINE MEDICAL GROUP 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	207U00000X	Nuclear Medicine Physician	G58652	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	:	1588798300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST NUCLEAR MEDICINE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 30978
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93130-0978
Country	:	US
Telephone Number	:	805-964-1814
Fax Number	:	805-964-7154

Provider Business Practice Location Address
First Line	:	229 W PUEBLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3804
Country	:	US
Telephone Number	:	805-563-5744
Fax Number	:	805-563-5747

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL STEVEN RIMKUS
Credential	:	M.D.
Telephone Number	:	805-563-5744

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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