Provider Demographics
NPI:1235418856
Name:ULTRASONIC RADIOLOGY
Entity Type:Organization
Organization Name:ULTRASONIC RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMGAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS,RDCS,RVT
Authorized Official - Phone:714-595-9012
Mailing Address - Street 1:800 S BROOKHURST ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4301
Mailing Address - Country:US
Mailing Address - Phone:714-595-9012
Mailing Address - Fax:
Practice Address - Street 1:1842 W LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5489
Practice Address - Country:US
Practice Address - Phone:714-595-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service