Provider Demographics
NPI:1376762773
Name:RAD, ALICE KANANI (RDMS , RDCS)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:KANANI
Last Name:RAD
Suffix:
Gender:F
Credentials:RDMS , RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 STANDFORD ST
Mailing Address - Street 2:#1
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-828-4208
Mailing Address - Fax:
Practice Address - Street 1:1327 STANFORD ST
Practice Address - Street 2:#1
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2513
Practice Address - Country:US
Practice Address - Phone:310-828-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG114Medicare ID - Type UnspecifiedPROVIDER NUMBER