Healthcare Provider Details

I. General information

NPI: 1174653315
Provider Name (Legal Business Name): THE RADIATION MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE D-101A
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

PO BOX 33865
SAN DIEGO CA
92163-3865
US

V. Phone/Fax

Practice location:
  • Phone: 858-505-4100
  • Fax:
Mailing address:
  • Phone: 858-888-7700
  • Fax: 858-888-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS MYKING
Title or Position: EXECUTIVE DIR, CFO
Credential: MBA
Phone: 619-220-4100