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NPI Code Detail

MEDICARE: EL CAMINO RADIOLOGISTS MEDICAL GROUP

MEDICARE: EL CAMINO RADIOLOGISTS 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
12085R0202XDiagnostic Radiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CI9619OTHERRAILROAD MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639126725
Entity Type Code : Organization
Provider Name (Legal Business Name) : EL CAMINO RADIOLOGISTS MEDICAL GROUP
Provider Business Mailing Address
First Line : PO BOX 6102
Second Line :
City : NOVATO
State : CA
Zip : 94948-6102
Country : US
Telephone Number : 415-884-3404
Fax Number : 415-883-1836
Provider Business Practice Location Address
First Line : 2500 GRANT RD
Second Line :
City : MOUNTAIN VIEW
State : CA
Zip : 94040-4302
Country : US
Telephone Number : 650-940-7044
Fax Number : 650-940-7134
Authorized Official
Title or Position : PRESIDENT
Name : VOLNEY VANDALSEM III
Credential : MD
Telephone Number : 650-940-7044
Provider Enumeration Date : 05/27/2006
Last Update Date : 02/25/2008

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Directions to “EL CAMINO RADIOLOGISTS MEDICAL GROUP ” Practice Location

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