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General NPI Number Information
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NPI Number | 1619987674
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Entity Type | Organization
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Legal Business Name | RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 1685 B COMMERCIAL WAY
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1703
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Country | US
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Telephone | 831-462-0151
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Fax | 831-464-8977
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Provider Business Mailing Address
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Address Line | 1661 SOQUEL DRIVE BUILDING G
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1709
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Country | US
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Telephone | 831-476-1542
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Fax | 831-464-8977
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH E AVERILL JR.
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Credential | MD
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Telephone | 831-476-1542
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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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