Healthcare Provider Details

I. General information

NPI: 1457513442
Provider Name (Legal Business Name): RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PLAZA DR 180
ROSEVILLE CA
95661-2865
US

IV. Provider business mailing address

1500 EXPO PKWY
SACRAMENTO CA
95815-4227
US

V. Phone/Fax

Practice location:
  • Phone: 916-791-8346
  • Fax: 916-791-8833
Mailing address:
  • Phone: 916-646-8300
  • Fax: 916-920-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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