Provider Demographics
NPI:1528012945
Name:DOWNEY RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:DOWNEY RADIOLOGY ASSOCIATES
Other - Org Name:DOWRAD MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-904-5000
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-0190
Mailing Address - Country:US
Mailing Address - Phone:805-522-5940
Mailing Address - Fax:805-522-6401
Practice Address - Street 1:11500 BROOKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4917
Practice Address - Country:US
Practice Address - Phone:844-596-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0077711Medicaid
CN5230OtherRAILROAD MEDICARE
HW13930Medicare ID - Type Unspecified
ZZZ54511ZOtherBLUE SHIELD
HW13930AMedicare ID - Type Unspecified
CAGR0077710Medicaid