Organization
ST. JUDE RADIOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY JACKSON MD (MEDICAL DIRECTOR / CEO)
(714) 992-3978
Entity
Organization
Contact information
Practice address
8070 ENTRADA DE LUZ E, SAN DIEGO, CA 92127-2561
(714) 992-3978
Mailing address
PO BOX 940, NEWBURY PARK, CA 91319-0940
(800) 317-5834
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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