Healthcare Provider Details

I. General information

NPI: 1578516829
Provider Name (Legal Business Name): RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 5TH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

1801 W OLYMPIC BLVD FILE 1315
PASADENA CA
91199-1315
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARJEEL H SABIR
Title or Position: AUTHORIZED OFFICIAL
Credential: DO
Phone: 858-658-6500