Healthcare Provider Details

I. General information

NPI: 1639499239
Provider Name (Legal Business Name): DELTA RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 TRINITY PKWY # 204
STOCKTON CA
95219-7286
US

IV. Provider business mailing address

PO BOX 15498
SACRAMENTO CA
95851-0498
US

V. Phone/Fax

Practice location:
  • Phone: 209-473-3316
  • Fax: 209-473-1492
Mailing address:
  • Phone: 559-455-4053
  • Fax: 559-455-4007

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: TERRY GOLDBERG
Title or Position: CEO
Credential:
Phone: 209-365-2539