Provider Demographics
NPI:1265901334
Name:RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC
Entity type:Organization
Organization Name:RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-455-4009
Mailing Address - Street 1:2410 SAMARITAN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3909
Mailing Address - Country:US
Mailing Address - Phone:408-371-0390
Mailing Address - Fax:408-371-0462
Practice Address - Street 1:3750 WHITMAN CIR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8326
Practice Address - Country:US
Practice Address - Phone:559-455-4042
Practice Address - Fax:916-533-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty