Healthcare Provider Details

I. General information

NPI: 1043681752
Provider Name (Legal Business Name): BEVERLY RADIOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST SUITE 101
FALLBROOK CA
92028-3081
US

IV. Provider business mailing address

521 E ELDER ST SUITE 101
FALLBROOK CA
92028-3081
US

V. Phone/Fax

Practice location:
  • Phone: 310-445-2000
  • Fax:
Mailing address:
  • Phone: 310-445-2000
  • Fax:

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: HOWARD G. BERGER
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 310-445-2000