Provider Demographics
NPI:1588798300
Name:SOUTH COAST NUCLEAR MEDICINE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SOUTH COAST NUCLEAR MEDICINE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:RIMKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-563-5744
Mailing Address - Street 1:PO BOX 30978
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-0978
Mailing Address - Country:US
Mailing Address - Phone:805-964-1814
Mailing Address - Fax:805-964-7154
Practice Address - Street 1:229 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3804
Practice Address - Country:US
Practice Address - Phone:805-563-5744
Practice Address - Fax:805-563-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58652207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087990Medicaid
CAW13089Medicare ID - Type UnspecifiedGROUP PROVIDER ID