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General NPI Number Information
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NPI Number | 1366416307
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Entity Type | Organization
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Legal Business Name | RADIOLOGY ASSOCIATES OF SAN LUIS OBISPO
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 12/05/2007
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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 | 93465-9737
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Country | US
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Telephone | 805-434-0829
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Fax | 805-434-0826
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Provider Business Mailing Address
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Address Line | PO BOX 2920
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City | ATASCADERO
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State | CA
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Zip | 93423-2920
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Country | US
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Telephone | 805-461-7080
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Fax | 805-464-0243
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. WILLIAM M. RUSSELL
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Credential | MD
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Telephone | 805-461-7080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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