Organization
SAN DIEGO REGIONAL P.E.T. CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM CLEARY (MANAGER)
(858) 499-0230
Entity
Organization
Contact information
Practice address
7625 MESA COLLEGE DR, 102, SAN DIEGO, CA 92111-5343
(858) 499-0230
(858) 499-0231
Mailing address
PO BOX 910026, SAN DIEGO, CA 92191-0026
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207U00000X
Nuclear Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ08027
BLUE SHIELD
—
Enumeration date
05/19/2006
Last updated
09/11/2025
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