MEDICARE: QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1013421866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, P.C.

Provider Business Mailing Address
First Line	:	3520 PIEDMONT RD NE STE 250
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1609
Country	:	US
Telephone Number	:	559-455-4026
Fax Number	:	916-533-0313

Provider Business Practice Location Address
First Line	:	14553 CYPRESS POINT TER
Second Line	:
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-6671
Country	:	US
Telephone Number	:	559-455-4026
Fax Number	:	916-533-0313

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	LYN MAYHUE
Credential	:
Telephone Number	:	559-455-4026

Provider Enumeration Date	:	11/30/2017
Last Update Date	:	06/16/2018

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