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General NPI Number Information
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NPI Number | 1538213681
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Entity Type | Organization
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Legal Business Name | LOS GATOS RADIOLOGY
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 815 POLLARD RD.
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City | LOS GATOS
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State | CA
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Zip | 95030
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Country | US
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Telephone | 888-582-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 2209 COFFEE RD STE M
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | KEITH FORD
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Credential |
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Telephone | 888-582-0814
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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 | G42474
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License Number State | CA
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