Organization
RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC
Active
Parent organization
RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC
Other names
Dominican MRI Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC
Authorized official
KENNETH E AVERILL JR. MD (PRESIDENT)
(831) 476-1542
Entity
Organization
Contact information
Practice address
1545 SOQUEL DRIVE, SANTA CRUZ, CA 95065-1705
(831) 476-2569
(831) 464-8977
Mailing address
1661 SOQUEL DRIVE, BUILDING G, SANTA CRUZ, CA 95065-1709
(831) 476-1542
(831) 464-8977
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ73806Z
—
CA
01
—
ZZZ74648Z
BLUE SHIELD
CA
Enumeration date
08/08/2006
Last updated
03/27/2008
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