Organization
ST JUDE RADIOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY A. JACKSON MD (CEO)
(559) 455-4109
Entity
Organization
Contact information
Practice address
101 E VALENCIA MESA DR, FULLERTON, CA 92835-3809
(714) 992-3000
(916) 533-0313
Mailing address
PO BOX 26570, FRESNO, CA 93729-6570
(714) 992-3978
(714) 446-5908
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Enumeration date
08/06/2018
Last updated
02/12/2021
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