Provider Demographics
NPI:1225526981
Name:RADGISTICS
Entity Type:Organization
Organization Name:RADGISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYTAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-853-7240
Mailing Address - Street 1:11755 VICTORY BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3461
Mailing Address - Country:US
Mailing Address - Phone:818-853-7240
Mailing Address - Fax:818-853-7241
Practice Address - Street 1:11755 VICTORY BLVD STE 108
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3461
Practice Address - Country:US
Practice Address - Phone:818-853-7240
Practice Address - Fax:818-853-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-28
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile