Healthcare Provider Details

I. General information

NPI: 1609802842
Provider Name (Legal Business Name): WEST RAD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100-A N TUSTIN AVE
SANTA ANA CA
92705-3509
US

IV. Provider business mailing address

PO BOX 11924
SANTA ANA CA
92711-1924
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-6055
  • Fax: 714-835-3287
Mailing address:
  • Phone: 714-835-3709
  • Fax: 714-836-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number042713
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number042713
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number042713
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number042713
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number042713
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042713
License Number StateCA

VIII. Authorized Official

Name: DR. MARK GEOFFERY STEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-835-6055