Organization Active NPI

San Diego Regional P.E.T. Center, LLC

  • Nuclear Medicine Physician
  • San Diego, CA
National Provider Identifier
1104879121
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Medicine PhysicianTaxonomy code 207U00000X
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

Updated by the provider on Sep 11, 2025

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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Nuclear Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

IdentifierTypeStateIssuer
ZZZ08027OtherBLUE SHIELD

National Provider Directory

National Provider Directory

Locations

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.

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

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.

Verify at the official NPI Registry.