Organization
PUEBLO RADIOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE HARTER MD (PRESIDENT)
(805) 682-7984
Entity
Organization
Contact information
Practice address
250 W PUEBLO ST, SANTA BARBARA, CA 93105-3805
(805) 682-7744
(805) 682-3321
Mailing address
DEPT LA 21613, PASADENA, CA 91185-1613
(949) 263-8620
(949) 263-1639
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0011030
—
CA
05
—
GR0011034
—
CA
05
—
GR0011035
—
CA
05
—
GR0011037
—
CA
05
—
GR0011038
—
CA
05
—
GR0011039
—
CA
05
—
GR001103A
—
CA
05
—
GR001103B
—
CA
05
—
GR001103C
—
CA
01
—
ZZZ50521Y
BS
CA
05
—
ZZZ73471Z
—
CA
Enumeration date
05/25/2006
Last updated
05/20/2008
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