Healthcare Provider Details

I. General information

NPI: 1831170851
Provider Name (Legal Business Name): RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 CREEKSIDE DR
FOLSOM CA
95630-3489
US

IV. Provider business mailing address

1500 EXPO PKWY
SACRAMENTO CA
95815-4227
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-0739
  • Fax: 916-983-3817
Mailing address:
  • Phone: 916-646-8406
  • Fax: 916-920-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JONATHAN BRESLAU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-646-8300