Provider Demographics
NPI:1154302651
Name:RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP
Entity Type:Organization
Organization Name:RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-646-8300
Mailing Address - Street 1:1500 EXPO PKWY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4227
Mailing Address - Country:US
Mailing Address - Phone:916-646-8406
Mailing Address - Fax:916-920-4434
Practice Address - Street 1:2 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 180
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-781-1221
Practice Address - Fax:916-797-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002851JMedicaid
CAGR002851JMedicaid