Provider Demographics
NPI:1497935266
Name:STANTON H. JOE, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STANTON H. JOE, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:SOUTHERN CALIFORNIA RADIOLOGY MEDICAL GROUP, A PROF. CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:JOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-790-9300
Mailing Address - Street 1:1809 VERDUGO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1402
Mailing Address - Country:US
Mailing Address - Phone:818-790-9300
Mailing Address - Fax:818-790-4564
Practice Address - Street 1:1809 VERDUGO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-9300
Practice Address - Fax:818-790-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22872261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16106AMedicare PIN