Individual
JEFFREY JAMES TODD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RT(R)
Contact information
Practice address
3170 FLORA ST, SAN LUIS OBISPO, CA 93401-6051
(805) 541-3174
(805) 541-6427
Mailing address
PO BOX 1665, SAN LUIS OBISPO, CA 93406-1665
(805) 541-3174
(805) 541-6427
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
RHT 45586
CA
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
FAC00029014
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
630000525
PALMETTO GBA
GA
05
—
ZZZ59902Z
—
CA
Enumeration date
05/17/2006
Last updated
04/07/2012
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