Organization
ST. JUDE RADIOLOGY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY ALLEN JACKSON MD (CEO)
(714) 992-3000
Entity
Organization
Contact information
Practice address
101 E VALENCIA MESA DR, FULLERTON, CA 92835-3809
(714) 992-3978
Mailing address
PO BOX 940, NEWBURY PARK, CA 91319-0940
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
02/19/2021
Last updated
02/19/2021
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