Healthcare Provider Details

I. General information

NPI: 1285666313
Provider Name (Legal Business Name): RADIOLOGY MEDICAL GROUP OF NAPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TRANCAS STREET
NAPA CA
94558
US

IV. Provider business mailing address

PO BOX 348120
SACRAMENTO CA
94589
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-4411
  • Fax: 707-252-2240
Mailing address:
  • Phone: 707-252-4411
  • Fax: 707-252-2240

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: ANDREW J. NICKS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 707-252-4411