Provider Demographics
NPI:1720042062
Name:CROWN VALLEY RADIOLOGISTS INC A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:CROWN VALLEY RADIOLOGISTS INC A PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-367-1010
Mailing Address - Street 1:27401 LOS ALTOS STE 150
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8013
Mailing Address - Country:US
Mailing Address - Phone:949-367-1010
Mailing Address - Fax:949-367-1011
Practice Address - Street 1:27401 LOS ALTOS STE 150
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8013
Practice Address - Country:US
Practice Address - Phone:949-367-1010
Practice Address - Fax:949-367-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15757Medicare PIN