| Organization Name: | PENINSULA ULTRASOUND, MAMMOGRAPHY AND RADIOLOGY SERVICES MED GROUP INC |
| NPI Number: | 1619066511 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BETH KLEINER (CEO) |
| Mailing Address: | 101 S San Mateo Dr Suite 201 San Mateo |
| State: | CA US |
| Postal Code: | 944013819 |
| Phone Number: | 6503431655 |
| Fax Number: | 6503431686 |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 06/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | G46504 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |