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General NPI Number Information
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NPI Number | 1255413811
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Entity Type | Organization
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Legal Business Name | RADIOLOGY MEDICAL MEDICAL GROUP
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1617 N CALIFORNIA ST STE 1A
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City | STOCKTON
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State | CA
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Zip | 95204-6117
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Country | US
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Telephone | 209-334-7810
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15498
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City | SACRAMENTO
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State | CA
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Zip | 95851-0498
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Country | US
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Telephone | 209-334-7810
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. TERRY GOLDBERG
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Credential |
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Telephone | 209-334-7810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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