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General NPI Number Information
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NPI Number | 1649441858
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Entity Type | Organization
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Legal Business Name | LJR NEURO INTERVENTIONAL MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 9888 GENESEE AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-1205
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Country | US
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Telephone | 858-626-6884
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Fax |
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Provider Business Mailing Address
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Address Line | 10150 SORRENTO VALLEY RD SUITE 320
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City | SAN DIEGO
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State | CA
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Zip | 92121-1635
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Country | US
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Telephone | 858-454-4235
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER H.B. MCCREIGHT
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Credential | M.D.
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Telephone | 858-454-4235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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