Provider Demographics
NPI:1265857759
Name:RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC.
Entity type:Organization
Organization Name:RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-476-1542
Mailing Address - Street 1:1661 SOQUEL DR STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1709
Mailing Address - Country:US
Mailing Address - Phone:831-476-1542
Mailing Address - Fax:831-464-8977
Practice Address - Street 1:911 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5606
Practice Address - Country:US
Practice Address - Phone:831-637-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ81760YOtherBLUE SHIELD OF CALIFORNIA
CAZZZ73806ZMedicare PIN