Healthcare Provider Details

I. General information

NPI: 1124267828
Provider Name (Legal Business Name): RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY AVE 200
SACRAMENTO CA
95825-6504
US

IV. Provider business mailing address

1500 EXPO PKWY
SACRAMENTO CA
95815-4227
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-1615
  • Fax: 916-924-3386
Mailing address:
  • Phone: 916-646-8300
  • Fax: 916-920-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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