Provider Demographics
NPI:1689843823
Name:DR. THOMAS ANDREW HERBOLD M.D.
Entity Type:Organization
Organization Name:DR. THOMAS ANDREW HERBOLD M.D.
Other - Org Name:WARNER DIAGNOSTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:818-598-0309
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2006
Mailing Address - Country:US
Mailing Address - Phone:818-598-0309
Mailing Address - Fax:818-347-0450
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:818-598-0309
Practice Address - Fax:818-347-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72292261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology