La Jolla Radiology Medical Group Therapy, Inc

Primary specialty

Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X

Legal business name

LA JOLLA RADIOLOGY MEDICAL GROUP THERAPY, INC

Practice address

9888 Genesee Ave
La Jolla, CA 92037-1205

Phone

(760) 599-9545

Fax

(760) 599-9549

NPI assigned

Nov 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Bourbeau

Title

Manager

Phone

(760) 599-9545

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1023185428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 SYCAMORE AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920817815",
            "telephone_number": "760-599-9545",
            "fax_number": "760-599-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "760-599-9545",
            "fax_number": "760-599-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA JOLLA RADIOLOGY MEDICAL GROUP THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "BOURBEAU",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "760-599-9545"
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G385890",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G501610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• La Jolla Orthopedic Trauma Inc
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• La Jolla Physical Therapy Center, Inc.
• La Jolla Psychological Solutions, Inc
• La Jolla Pulmonary and Critical Care Inc.
• La Jolla Recovery Inc
• La Jolla Recovery Inc
• La Jolla Sol Ventures Inc
• La Jolla Urology
• La Jolla Wellness, Licensed Clinical Social Worker, Inc.

• Radiation Oncology Clinic/Center in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Radiation Oncology Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.