Organization
MODESTO RADIOLOGICAL MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E MOORE (CFO/COO)
(559) 455-4009
Entity
Organization
Contact information
Practice address
3421 DEEP WATERS CT, SIMI VALLEY, CA 93065-0587
(559) 455-4009
(916) 533-0313
Mailing address
PO BOX 7326, SAN FRANCISCO, CA 94120-7326
(559) 455-4009
(916) 533-0313
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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