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General NPI Number Information
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NPI Number | 1487945754
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Entity Type | Organization
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Legal Business Name | RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 1880 SIERRA GARDENS DR 200
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City | ROSEVILLE
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State | CA
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Zip | 95661-2958
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Country | US
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Telephone | 916-878-3436
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Fax | 916-771-5611
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Provider Business Mailing Address
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Address Line | 1500 EXPO PKWY
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City | SACRAMENTO
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State | CA
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Zip | 95815-4227
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Country | US
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Telephone | 916-646-8300
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Fax | 916-561-8620
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN BRESLAU
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Credential | M.D.
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Telephone | 916-646-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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