Basic Information
| Provider Information | |||||||||
| NPI: | 1194149021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 B GALE WILSON BLVD | ||||||||
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| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945333552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076465000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3520 PIEDMONT RD NE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048702802 | ||||||||
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| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 02/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | PRETORIUS | ||||||||
| AuthorizedOfficialFirstName: | EUGUEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4046253526 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.