Organization
LA JOLLA RADIOLOGY MEDICAL GROUP - DIAGNOSIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER H.B. MCCREIGHT M.D. (PRESIDENT)
(858) 454-4235
Entity
Organization
Contact information
Practice address
10150 SORRENTO VALLEY RD, SUITE 320, SAN DIEGO, CA 92121-1635
(858) 454-4235
(858) 454-4644
Mailing address
P.O. BOX 2570, NEWBURY PARK, CA 91319-2570
(800) 386-8024
(805) 375-8900
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0006796
—
CA
05
—
GR0006799
—
CA
01
—
ZZZ00191Z
BLUE SHIELD
—
01
—
ZZZ00192Z
BLUE SHIELD
—
01
—
ZZZ00872Z
BLUE SHIELD
—
01
—
ZZZ00873Z
BLUE SHIELD
—
01
—
ZZZ23443Z
BLUE SHIELD
—
01
—
ZZZ71703Z
BLUE SHIELD
—
05
—
ZZZ71703Z
—
CA
01
—
ZZZ73863Z
BLUE SHIELD
—
05
—
ZZZ73863Z
—
CA
01
—
ZZZ777070Z
BLUE SHIELD
—
Enumeration date
05/17/2006
Last updated
06/22/2009
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