St. Jude Radiology Medical Group, INC.
Radiology, Diagnostic Radiology in South Pasadena, CA. Organization (NPI-2).
NPI number1043732001
StatusActive
Last updated in NPPESMar 17, 2018
Details
- NPI
- 1043732001
- Entity type
- Organization (NPI-2)
- Legal business name
- St. Jude Radiology Medical Group, INC.
- Organization subpart
- No
- Enumeration date
- Jul 12, 2017
- Last updated
- Mar 17, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0202X | Radiology, Diagnostic Radiology | – | – | Yes |
Practice location
2059 Stratford AveSouth Pasadena, CA 91030-4640
Phone 714-992-3978
Mailing address
Po Box 940Newbury Park, CA 91319-0940
Other practice locations
2311 4th St Apt 321
Santa Monica, CA 90405-3459
Santa Monica, CA 90405-3459
Phone 714-992-3978
Authorized official
Bradley A. Jackson
Medical Director / Ceo
7149923978
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