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General NPI Number Information
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NPI Number | 1033688106
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Entity Type | Organization
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Legal Business Name | RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 6729 MONTE RD
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-8050
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Country | US
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Telephone | 408-371-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 SAMARITAN DR STE 102
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City | SAN JOSE
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State | CA
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Zip | 95124-3909
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Country | US
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Telephone | 408-371-0390
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Fax | 408-371-0462
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Authorized Official
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Title or Position | CREDENTIALING LEAD
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Name | SABRINA BRUCE
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Credential |
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Telephone | 559-455-4009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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