Active NPI
San Diego Regional P.E.T. Center, LLC
- Nuclear Medicine Physician
- San Diego, CA
National Provider Identifier
1104879121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Medicine Physician
- Legal business name
- SAN DIEGO REGIONAL P.E.T. CENTER, LLC
- Practice address
- 7625 Mesa College Dr
102
San Diego, CA 92111-5343 - Phone
- (858) 499-0230
- Fax
- (858) 499-0231
- NPI assigned
- May 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Tom Cleary
- Title
- Manager
- Phone
- (858) 499-0230
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | |||
| Nuclear Medicine Physician | 207U00000X | Primary |
Addresses
Primary practice location
7625 Mesa College Dr
102
San Diego, CA 92111-5343
Mailing address
PO Box 910026
San Diego, CA 92191-0026
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ08027 | Other | BLUE SHIELD |
National Provider Directory
National Provider DirectoryLocations
7625 Mesa College Dr
Ste 102
San Diego, CA 92111
Phone (858) 499-0230
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nuclear Imaging & Therapy Physician
- San Diego, CA
- NPI 1356311906
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1104879121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 910026",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921910026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7625 MESA COLLEGE DR",
"address_2": "102",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921115343",
"telephone_number": "858-499-0230",
"fax_number": "858-499-0231"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAN DIEGO REGIONAL P.E.T. CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-19",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "CLEARY",
"authorized_official_first_name": "TOM",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "858-499-0230",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207U00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nuclear Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "ZZZ08027",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in San Diego, CA
- San Diego Psychotherapy
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- San Diego Regional Head & Neck Center
- San Diego Regional Health Information Exchange
- San Diego Rehab
- San Diego Rehab and Fitness
- San Diego Rescue Mission
- San Diego Rescue Mission
- San Diego Second Chance Program
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.