Basic Information
| Provider Information | |||||||||
| NPI: | 1215406384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 SAMARITAN DR STE 101 | ||||||||
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| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083710390 | ||||||||
| FaxNumber: | 4083710462 | ||||||||
| Practice Location | |||||||||
| Address1: | 3224 FRESHWATER CRK | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959732120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594554042 | ||||||||
| FaxNumber: | 9165330313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2018 | ||||||||
| LastUpdateDate: | 11/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | BRUCE | ||||||||
| AuthorizedOfficialFirstName: | SABRINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING LEAD | ||||||||
| AuthorizedOfficialTelephone: | 5594554009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.