Organization
MODESTO RADIOLOGICAL MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK MOORE (COO/CFO)
(209) 342-5946
Entity
Organization
Contact information
Practice address
2132 LYSANDER WAY, ROSEVILLE, CA 95661-3220
(559) 455-4009
(916) 533-0023
Mailing address
1524 MCHENRY AVE, SUITE 430, MODESTO, CA 95350-4500
(559) 455-4009
(916) 533-0023
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
11/25/2015
Last updated
11/25/2015
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