Provider Demographics
NPI:1437127693
Name:THOUSAND OAKS DIAGNOSTIC IMAGING CENTER
Entity Type:Organization
Organization Name:THOUSAND OAKS DIAGNOSTIC IMAGING CENTER
Other - Org Name:CONEJO MEDICAL MAGNETIC RESONANCE SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-7755
Mailing Address - Street 1:PO BOX 51038
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5338
Mailing Address - Country:US
Mailing Address - Phone:800-210-0857
Mailing Address - Fax:805-375-8903
Practice Address - Street 1:2180 LYNN ROAD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-495-9442
Practice Address - Fax:805-496-6695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOUSAND OAKS DIAGNOSTIC IMAGING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0008550Medicaid