Basic Information
| Provider Information | |||||||||
| NPI: | 1578816617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO DIAGNOSTIC RADIOLOGY MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23540 | ||||||||
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| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921933540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585650950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 255 N ELM ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602940870 | ||||||||
| FaxNumber: | 7602940871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2012 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | CHEN | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8585650950 | ||||||||
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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 | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.