Organization Name: | RADIOLOGY ASSOCIATES OF SAN LUIS OBISPO |
NPI Number: | 1306813886 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM M. RUSSELL (MANAGING PARTNER) |
Mailing Address: | 921 Oak Park Blvd Ste 102 Pismo Beach |
State: | CA US |
Postal Code: | 93449 |
Phone Number: | 8057797900 |
Fax Number: | 8057797910 |
NPI Enumeration Date: | 03/03/2006 |
NPI Last Update Date: | 12/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |