Organization
MODESTO RADIOLOGICAL MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E MOORE (COO)
(209) 342-5946
Entity
Organization
Contact information
Practice address
4525 YERBA SANTA DR, SAN DIEGO, CA 92115-1032
(559) 455-4009
(916) 533-0313
Mailing address
1524 MCHENRY AVE, STE 430, MODESTO, CA 95350-4500
(559) 455-4009
(916) 533-0313
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
05/11/2016
Last updated
05/11/2016
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