Organization
TUSTIN TELERADIOLOGY MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS L ATLAS MD (OWNER)
(714) 665-6900
Entity
Organization
Contact information
Practice address
13422 NEWPORT AVE, SUITE I, TUSTIN, CA 92780-3746
(714) 665-6900
(714) 665-6904
Mailing address
13422 NEWPORT AVE, SUITE I, TUSTIN, CA 92780-3746
(714) 665-6900
(714) 665-6904
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
G74535
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002082232
—
NV
05
—
00G745350
—
CA
01
—
ZZZ57939Z
BLUE SHIELD GROUP NUMBER
CA
Enumeration date
06/04/2006
Last updated
01/01/2019
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