Provider Demographics
NPI:1710337357
Name:BURBANK IMAGING AND OPEN MRI INC
Entity Type:Organization
Organization Name:BURBANK IMAGING AND OPEN MRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLBAHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-478-8060
Mailing Address - Street 1:333 E MAGNOLIA BLVD STE 104
Mailing Address - Street 2:#104
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:818-478-2960
Practice Address - Street 1:333 E MAGNOLIA BLVD STE 104
Practice Address - Street 2:#104
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1198
Practice Address - Country:US
Practice Address - Phone:818-478-8060
Practice Address - Fax:818-478-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABT-1011543261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology