Provider Demographics
NPI:1467984492
Name:JOLI MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:JOLI MEDICAL MANAGEMENT, INC.
Other - Org Name:CAL-STATE RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFCIER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MELINDA
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-854-3001
Mailing Address - Street 1:1772J E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:#193
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6109
Mailing Address - Country:US
Mailing Address - Phone:877-854-3001
Mailing Address - Fax:877-854-3002
Practice Address - Street 1:2139 TAPO ST
Practice Address - Street 2:SUITE# 226
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3478
Practice Address - Country:US
Practice Address - Phone:877-854-3001
Practice Address - Fax:877-854-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service