Healthcare Provider Details

I. General information

NPI: 1740232776
Provider Name (Legal Business Name): X-RAY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 ALVARADO RD SUITE 108
LA MESA CA
91941-3616
US

IV. Provider business mailing address

10 LITTLE BROOK RD
WEST WAREHAM MA
02576-1222
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-2770
  • Fax: 619-460-2774
Mailing address:
  • Phone: 800-841-5200
  • Fax: 508-273-1241

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: HARRY PETER ELLISON
Title or Position: PRESIDENT
Credential: MD
Phone: 619-460-2770