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General NPI Number Information
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NPI Number | 1689627317
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Entity Type | Organization
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Legal Business Name | LA JOLLA RADIOLOGY MEDICAL GROUP - DIAGNOSIS, INC.
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 06/22/2009
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Provider Practice Location 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 | 858-454-4644
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Provider Business Mailing Address
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Address Line | P.O. BOX 2570
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City | NEWBURY PARK
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State | CA
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Zip | 91319-2570
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Country | US
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Telephone | 800-386-8024
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Fax | 805-375-8900
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Authorized Official
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Title or Position | PRESIDENT
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Name | 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 | 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 | 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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