Provider Demographics
NPI:1588199210
Name:FOOTHILL IMAGING CENTER, INC
Entity Type:Organization
Organization Name:FOOTHILL IMAGING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-768-0552
Mailing Address - Street 1:7148 1/2 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2781
Mailing Address - Country:US
Mailing Address - Phone:800-768-0552
Mailing Address - Fax:800-688-0550
Practice Address - Street 1:7148 1/2 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2781
Practice Address - Country:US
Practice Address - Phone:800-768-0552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3638261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A3638OtherMEDICAL LICENSE