Provider Demographics
NPI:1790032753
Name:VALLEY RADIOLOGY CONSULTANTS MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:VALLEY RADIOLOGY CONSULTANTS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MUEHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-520-8551
Mailing Address - Street 1:1340 W VALLEY PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-2136
Mailing Address - Country:US
Mailing Address - Phone:760-520-8500
Mailing Address - Fax:
Practice Address - Street 1:10225 AUSTIN DR STE 105
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1521
Practice Address - Country:US
Practice Address - Phone:619-797-8248
Practice Address - Fax:619-399-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0017534Medicaid
ZZZ00722ZOtherBLUE SHIELD
CAGR0017534Medicaid