Provider Demographics
NPI:1619437373
Name:I V RADIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:I V RADIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-375-8823
Mailing Address - Street 1:1525 RANCHO CONEJO BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1448
Mailing Address - Country:US
Mailing Address - Phone:805-375-8823
Mailing Address - Fax:877-817-2046
Practice Address - Street 1:9178 EAGLE RIVER LN
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-6819
Practice Address - Country:US
Practice Address - Phone:805-375-8823
Practice Address - Fax:877-817-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty