Organization
NORTH COAST IMAGING RADIOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON GARY BECK (MANAGER)
(909) 347-9340
Entity
Organization
Contact information
Practice address
36485 INLAND VALLEY DR, WILDOMAR, CA 92595-9681
(951) 677-9713
(951) 677-9762
Mailing address
8605 SANTA MONICA BLVD, PMB 25192, WEST HOLLYWOOD, CA 90069-4109
(800) 880-2973
(951) 600-4493
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0004490
—
CA
05
—
GR0004492
—
CA
01
—
ZZZ40340Z
BLUE SHIELD
CA
01
—
ZZZ86398Z
BLUE SHIELD
—
Enumeration date
05/18/2006
Last updated
01/26/2024
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