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Organization
LA JOLLA RADIOLOGY MEDICAL GROUP THERAPY, INC
Active
Organization
LA JOLLA RADIOLOGY MEDICAL GROUP THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH BOURBEAU (MANAGER)
(760) 599-9545
Entity
Organization
Contact information
Practice address
9888 GENESEE AVE, LA JOLLA, CA 92037-1205
(760) 599-9545
(760) 599-9549
Mailing address
916 SYCAMORE AVE, VISTA, CA 92081-7815
(760) 599-9545
(760) 599-9549
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G385890
—
CA
05
—
00G501610
—
CA
Enumeration date
11/29/2006
Last updated
02/01/2008
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