Provider Demographics
NPI: | 1558960161 |
---|---|
Name: | ANTELOPE VALLEY OUTPATIENT IMAGING CENTER, LLC |
Entity Type: | Organization |
Organization Name: | ANTELOPE VALLEY OUTPATIENT IMAGING CENTER, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | EDWARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MIRZABEGIAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 661-949-5533 |
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: | 855-504-4544 |
Mailing Address - Fax: | 805-577-2018 |
Practice Address - Street 1: | 38209 47TH ST E STE D |
Practice Address - Street 2: | |
Practice Address - City: | PALMDALE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93552-3113 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-726-6050 |
Practice Address - Fax: | 661-951-4464 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-10-23 |
Last Update Date: | 2020-10-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Single Specialty |