Provider Demographics
NPI:1558695585
Name:WARNER DIAGNOSTIC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WARNER DIAGNOSTIC A MEDICAL CORPORATION
Other - Org Name:THOMAS A. HERBOLD MD
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HERBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-654-1867
Mailing Address - Street 1:700 CREEKMONT CT
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1404
Mailing Address - Country:US
Mailing Address - Phone:805-746-1113
Mailing Address - Fax:805-639-4122
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE #104
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-347-0348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology