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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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