Provider Demographics
NPI:1720322894
Name:STAT RADIOLOGY MEDICAL CORPORATION
Entity type:Organization
Organization Name:STAT RADIOLOGY MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOELLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-546-3800
Mailing Address - Street 1:13915 DANIELSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-8884
Mailing Address - Country:US
Mailing Address - Phone:858-546-3800
Mailing Address - Fax:858-546-3900
Practice Address - Street 1:13915 DANIELSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-8884
Practice Address - Country:US
Practice Address - Phone:858-546-3800
Practice Address - Fax:858-546-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty