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General NPI Number Information
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NPI Number | 1730353137
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Entity Type | Organization
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Legal Business Name | DELTA RADIOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 2320 N CALIFORNIA ST SUITE 3
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City | STOCKTON
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State | CA
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Zip | 95204-5509
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Country | US
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Telephone | 209-466-5028
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Fax | 209-466-5461
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Provider Business Mailing Address
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Address Line | PO BOX 15498
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City | SACRAMENTO
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State | CA
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Zip | 95851-0498
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Country | US
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Telephone | 559-455-4000
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Fax | 559-455-4007
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Authorized Official
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Title or Position | CEO
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Name | TERRY GOLDBERG
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Credential |
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Telephone | 209-334-4416
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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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