Provider Demographics
NPI:1730477340
Name:ADVANCED RADIOLOGY NETWORK
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGY NETWORK
Other - Org Name:ADVANCED RADIOLOGY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-383-4674
Mailing Address - Street 1:13547 VENTURA BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3825
Mailing Address - Country:US
Mailing Address - Phone:877-383-4674
Mailing Address - Fax:
Practice Address - Street 1:13547 VENTURA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3825
Practice Address - Country:US
Practice Address - Phone:877-383-4674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-17
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)