Provider Demographics
NPI:1003415613
Name:ANTELOPE VALLEY OUTPATIENT IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:ANTELOPE VALLEY OUTPATIENT IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZABEGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-949-5533
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-0190
Mailing Address - Country:US
Mailing Address - Phone:855-504-4544
Mailing Address - Fax:805-577-2018
Practice Address - Street 1:38925 TRADE CENTER DR UNIT E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3655
Practice Address - Country:US
Practice Address - Phone:661-726-6050
Practice Address - Fax:661-951-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty