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Organization
RADIOLOGY MEDICAL MEDICAL GROUP
Active
Organization
RADIOLOGY MEDICAL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRY GOLDBERG (CEO)
(209) 334-7810
Entity
Organization
Contact information
Practice address
1617 N CALIFORNIA ST, STE 1A, STOCKTON, CA 95204-6117
(209) 334-7810
Mailing address
PO BOX 15498, SACRAMENTO, CA 95851-0498
(209) 334-7810
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ00340Z
BLUE SHIELD
CA
Enumeration date
10/20/2006
Last updated
08/22/2020
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