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General NPI Number Information
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NPI Number | 1326888140
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Entity Type | Organization
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Legal Business Name | RADIOLOGY ASSOCIATES OF SAN LUIS OBISPO, A MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1310 LAS TABLAS RD STE 103
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City | TEMPLETON
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State | CA
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Zip | 93465-9746
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Country | US
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Telephone | 805-461-7080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3242
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3242
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Country | US
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Telephone | 805-461-7080
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | MARCI MILLER
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Credential |
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Telephone | 805-434-8679
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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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