Healthcare Provider Details

I. General information

NPI: 1215406384
Provider Name (Legal Business Name): RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 FRESHWATER CRK
CHICO CA
95973-2120
US

IV. Provider business mailing address

2410 SAMARITAN DR STE 101
SAN JOSE CA
95124-3909
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-4042
  • Fax: 916-533-0313
Mailing address:
  • Phone: 408-371-0390
  • Fax: 408-371-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SABRINA BRUCE
Title or Position: CREDENTIALING LEAD
Credential:
Phone: 559-455-4009