Provider Demographics
NPI:1164631081
Name:FAMILY RADIOLOGY INC.
Entity Type:Organization
Organization Name:FAMILY RADIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-530-2624
Mailing Address - Street 1:3440 LOMITA BLVD STE 151
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4865
Mailing Address - Country:US
Mailing Address - Phone:310-530-2624
Mailing Address - Fax:
Practice Address - Street 1:3440 LOMITA BLVD STE 151
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4865
Practice Address - Country:US
Practice Address - Phone:310-530-2624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER
CA=========OtherTAX ID NUMBER