| Organization Name: | LA JOLLA RADIOLOGY MEDICAL GROUP THERAPY, INC |
| NPI Number: | 1023185428 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELIZABETH BOURBEAU (MANAGER) |
| Mailing Address: | 9888 Genesee Ave La Jolla |
| State: | CA US |
| Postal Code: | 920371205 |
| Phone Number: | 7605999545 |
| Fax Number: | 7605999549 |
| NPI Enumeration Date: | 11/29/2006 |
| NPI Last Update Date: | 02/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QX0203X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Oncology, Radiation |
| Taxonomy Definition: | |