Healthcare Provider Details

I. General information

NPI: 1184871386
Provider Name (Legal Business Name): SEAN MURRAY MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 PHELPS AVE
COALINGA CA
93210-9609
US

IV. Provider business mailing address

4536 BROADWAY UNIT 906
SALIDA CA
95368-2037
US

V. Phone/Fax

Practice location:
  • Phone: 805-610-2945
  • Fax: 805-926-3961
Mailing address:
  • Phone: 209-577-9900
  • Fax: 209-577-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG78213
License Number StateCA

VIII. Authorized Official

Name: SEAN P MURRAY
Title or Position: PRESIDENT
Credential: MD
Phone: 559-783-1181