Organization
EASTERN SIERRA RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WILLARD NESSON M.D. (PRESIDENT)
(626) 445-0004
Entity
Organization
Contact information
Practice address
100 FALLS CANYON RD, AVALON, CA 90704-1563
(310) 510-0700
(626) 445-0302
Mailing address
333 N SANTA ANITA AVE, SUITE #9, ARCADIA, CA 91006-2863
(626) 445-0004
(626) 445-0302
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A22120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A221201
—
CA
01
—
A22120
BLUE CROSS
CA
01
—
ZZZ04744Z
BLUE SHIELD
CA
Enumeration date
08/25/2006
Last updated
09/17/2007
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