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General NPI Number Information
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NPI Number | 1982508016
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Entity Type | Organization
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Legal Business Name | PWS RADIOLOGY CONSULTING PC
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Dates
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Enumeration Date | 10/03/2026
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Last Update Date | 10/03/2026
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Provider Practice Location Address
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Address Line | 1573 COPA DE ORO DR
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City | LA JOLLA
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State | CA
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Zip | 92037-7806
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Country | US
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Telephone | 858-761-7842
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Fax |
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Provider Business Mailing Address
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Address Line | 1573 COPA DE ORO DR
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City | LA JOLLA
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State | CA
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Zip | 92037-7806
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Country | US
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Telephone | 858-761-7842
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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. AGNES CHRISTINE SANTOSA
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Credential | MD
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Telephone | 858-761-7842
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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 | NULL
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