MODESTO RADIOLOGICAL MEDICAL GROUP, INC (NPI# 1023482296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023482296 |
| Entity Type | Organization |
| Organization Name | MODESTO RADIOLOGICAL MEDICAL GROUP, INC |
| Practice Address |
6729 Monte Rd San Luis Obispo CA 93401-8050 |
| Mailing Address |
1524 Mchenry Ave Suite 430 Modesto CA 95350-4500 |
| Practice Telephone | 5594554009 |
| Practice Fax Number | 9165330023 |
| Mailing Telephone | 5594554009 |
| Mailing Fax Number | 9165330023 |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |
| Authorized Official Name | MR. MARK MOORE (CFO/COO) |
| Authorized Official Telephone | 2093425946 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255872552 | Modesto Radiological Medical Group, Inc | Radiology | 3421 Deep Waters Ct, Simi Valley, CA 93065-0587 | 2017-03-20 |
| 1134670656 | Modesto Radiological Medical Group, Inc | Radiology | 8673 Julie Lynne Cir, Tracy, CA 95304-9207 | 2016-10-19 |
| 1073969838 | Modesto Radiological Medical Group, Inc | Radiology | 148 Beachview Ave, Santa Cruz, CA 95060-3008 | 2016-05-11 |
| 1992170542 | Modesto Radiological Medical Group, Inc | Radiology | 728 Murphy Dr, San Mateo, CA 94402-3421 | 2015-12-08 |
| 1861866022 | Modesto Radiological Medical Group, Inc | Radiology | 1648 Dalton Rd, Palos Verdes Estates, CA 90274-1835 | 2015-11-25 |
| 1760856934 | Modesto Radiological Medical Group, Inc | Radiology | 2132 Lysander Way, Roseville, CA 95661-3220 | 2015-11-25 |
| 1154808095 | Modesto Radiological Medical Group, Inc | Radiology | 3750 Whitman Cir, Carmel, CA 93923-8326 | 2018-07-24 |
| 1881198604 | Modesto Radiological Medical Group, Inc | Radiology | 1202 Chelshurst Way, Spring, TX 77379-3247 | 2018-03-19 |
| 1063953362 | Modesto Radiological Medical Group, Inc | Radiology | 1200 4th St, Apt 103, San Francisco, CA 94158-2392 | 2017-03-20 |
| 1265973556 | Modesto Radiological Medical Group, Inc | Radiology | 6043 E Birdcage Ct, Orange, CA 92869-6015 | 2017-03-20 |
| Street Address |
6729 MONTE RD |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93401-8050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497228399 | Barbara Jean Morrow | Dental Hygienist | 2191 Johnson Avenue, San Luis Obispo, CA 93401 | 2019-01-03 |
| 1104307743 | Griffith Jennings | Counselor | 1225 Kendal Rd, San Luis Obispo, CA 93401 | 2018-08-22 |
| 1124518808 | Joy L Delaluna | Licensed Psychiatric Technician | 692 Evens Rd, San Luis Obispo, CA 93401 | 2018-05-17 |
| 1982192084 | Sierra Mental Wellness Group | Community/Behavioral Health | 2180 B Johnson Avenue, San Luis Obispo, CA 93401 | 2018-04-25 |
| 1326554403 | Veronica Chanel Laguna | Case Manager/Care Coordinator | 1065 Kansas Ave., San Luis Obispo, CA 93401 | 2017-12-27 |
| 1043739782 | Janette Lynn Branca | Case Manager/Care Coordinator | 285 South Street, Suit J, San Louis Obispo, CA 93401 | 2017-09-13 |
| 1588194104 | Adv Vision LLC | Optometrist | 835 Aero Vista Pl, #110, San Luis Obispo, CA 93401 | 2017-06-15 |
| 1508395880 | Samantha Clay | Counselor | 1255 Kendall Road, San Luis Obispo, CA 93401 | 2017-06-08 |
| 1659804771 | Sara Anne Powers | Counselor | 697 Higuera Street D, San Luis Obispo, CA 93401 | 2017-04-05 |
| 1508306010 | Russell Piazza | Pharmacist | 873 Ricardo Court, San Luis Obispo, CA 93401 | 2017-03-02 |
| Find all providers in zip 93401 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366463879 | Robert D Henretig | Radiology | 2180 Johnson Ave, Ste A, San Luis Obispo, CA 93401-4513 | 2006-07-21 |
| 1619963386 | Richard Alan Berg | Radiology | 5882 Birkdale Ln, San Luis Obispo, CA 93401-8906 | 2005-09-27 |
| 1639175672 | Kenneth Dale Krone | Radiology | 1100 Monterey St, Suite 210, San Luis Obispo, CA 93401-3102 | 2005-06-23 |
| 1649682840 | San Luis Imaging Medical Group, Inc | Radiology | 1100 Monterey St, 200, San Luis Obispo, CA 93401-3102 | 2014-05-22 |
| 1003187881 | Magnetic Resonance Imaging of San Luis Obispo, Inc. | Radiology | 1064 Murray Ave, San Luis Obispo, CA 93405-1806 | 2012-01-25 |
| 1598811580 | San Luis Diagnostic Medical Associates | Radiology | 1100 Monterey St, Suite 210, San Luis Obispo, CA 93401-3102 | 2007-01-25 |
| 1093874075 | Gary Martin Hatch | Radiology | 1100 Monterey St, Suite 210, San Luis Obispo, CA 93401-3102 | 2006-12-06 |
| 1316011083 | Lisa Marie Wieler | Radiology | 1100 Monterey St, Suite 210, San Luis Obispo, CA 93401-3102 | 2006-11-17 |
| 1619047891 | Fred Steve Vernacchia | Radiology | 1100 Monterey St, Suite 210, San Luis Obispo, CA 93401-3102 | 2006-11-08 |
| 1740206606 | Dieter Ernst Eckert | Radiology | 1551 Bishop St, San Luis Obispo, CA 93401-4635 | 2006-07-14 |
| Find all providers in SAN LUIS OBISPO | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93401 |
Please comment or provide details below to improve the information on MODESTO RADIOLOGICAL MEDICAL GROUP, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.