Healthcare Provider Details

I. General information

NPI: 1982508016
Provider Name (Legal Business Name): PWS RADIOLOGY CONSULTING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 COPA DE ORO DR
LA JOLLA CA
92037-7806
US

IV. Provider business mailing address

1573 COPA DE ORO DR
LA JOLLA CA
92037-7806
US

V. Phone/Fax

Practice location:
  • Phone: 858-761-7842
  • Fax:
Mailing address:
  • Phone: 858-761-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AGNES CHRISTINE SANTOSA
Title or Position: PRESIDENT
Credential: MD
Phone: 858-761-7842