Eastern Sierra Radiology
Organization Active NPI Diagnostic Radiology Physician · Avalon, CA
NPI 1417065103 · NPPES record last updated Sep 17, 2007
Key facts
- NPI
- 1417065103
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- A22120 (CA)
- Legal business name
- EASTERN SIERRA RADIOLOGY
- Practice address
- 100 Falls Canyon Rd
Avalon, CA 90704-1563 - Phone
- (310) 510-0700
- Fax
- (626) 445-0302
- NPI assigned
- Aug 25, 2006
- Organization subpart
- No
Authorized official
- Name
- John Willard Nesson, M.D.
- Title
- President
- Phone
- (626) 445-0004
National Provider Directory
Locations
333 N Santa Anita Ave
Ste 9
Arcadia, CA 91006
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | A22120 | CA | Yes |
Addresses
Primary practice location
100 Falls Canyon Rd
Avalon, CA 90704-1563
Mailing address
333 N Santa Anita Ave
Suite #9
Arcadia, CA 91006-2863
Phone (626) 445-0004
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A221201 | Medicaid | CA | |
| ZZZ04744Z | Other | CA | BLUE SHIELD |
| A22120 | Other | CA | BLUE CROSS |
Other providers in Avalon, CA
- Catalina Island Medical Center
- City of Avalon Director of Finance
- Katherine Frame Coleman
- Jennifer Frances Diaz
- Santa Ann Dominguez
- Catherine Phyllis Egan
- Elizabeth Ann Fellows
- Marie Gertrude Fimbres
- Mark A Hamilton
- Paul David Heiderscheidt
All providers in Avalon, CA · Diagnostic Radiology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.