=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134344146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CURTIS & ASSOCIATES DIAGNOSTIC RADIOLOGY MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 355 MESA COVE
-----------------------------------------------------
City | INDIAN WELLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92210-7140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-341-2723
-----------------------------------------------------
Fax | 760-341-8574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 355 MESA COVE
-----------------------------------------------------
City | INDIAN WELLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92210-7140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-341-2723
-----------------------------------------------------
Fax | 760-341-8574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT VICE PRESIDENT
-----------------------------------------------------
Name | MR. STEPHEN JON CURTIS SR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 760-341-2723
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | G14719
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------