Organization
ONLINE RADIOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL SALEN (M.D., CFO)
(951) 786-0801
Entity
Organization
Contact information
Practice address
512 AVOCADO AVE, CORONA DEL MAR, CA 92625-1918
(949) 673-2533
Mailing address
75 REMITTANCE DR, DEPT. 6620, CHICAGO, IL 60675-6620
(888) 412-3639
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G48368
CA
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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