Provider Demographics
NPI: | 1770195224 |
---|---|
Name: | F&M RADIOLOGY MEDICAL CENTER INC |
Entity Type: | Organization |
Organization Name: | F&M RADIOLOGY MEDICAL CENTER INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RAY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SALARI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 818-708-6163 |
Mailing Address - Street 1: | 20011 VENTURA BLVD # 1002 |
Mailing Address - Street 2: | |
Mailing Address - City: | WOODLAND HILLS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91364-2573 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-708-6163 |
Mailing Address - Fax: | 818-340-5537 |
Practice Address - Street 1: | 318 W COLORADO ST STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | GLENDALE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91204-1670 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-708-6163 |
Practice Address - Fax: | 818-340-5537 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | F&M RADIOLOGY MEDICAL CENTER INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-08-17 |
Last Update Date: | 2020-08-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology |