Provider Demographics
NPI:1164564597
Name:VENTURA IMAGING AND RADIOLOGY CENTER
Entity Type:Organization
Organization Name:VENTURA IMAGING AND RADIOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEDAYAT
Authorized Official - Middle Name:ED
Authorized Official - Last Name:GOLCHEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-905-7323
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE # 787
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-905-7323
Mailing Address - Fax:818-783-6108
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE # 787
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-905-7323
Practice Address - Fax:818-783-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA040588261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA040588OtherMEDICAL LICENSE