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General NPI Number Information
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NPI Number | 1003695008
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Entity Type | Organization
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Legal Business Name | RADICAL MEDICAL INC
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 166 GEARY ST STE 1500
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-5628
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Country | US
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Telephone | 562-503-4668
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Fax |
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Provider Business Mailing Address
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Address Line | 32565 GOLDEN LANTERN ST STE B270
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City | DANA POINT
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State | CA
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Zip | 92629-3247
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Country | US
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Telephone | 562-503-4668
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Fax | 562-457-3615
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Authorized Official
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Title or Position | SECRETARY
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Name | BENJAMIN ROSTOKER
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Credential |
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Telephone | 562-503-4668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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