Provider Demographics
NPI:1780630236
Name:WILSHIRE IMAGING GROUP, INC
Entity Type:Organization
Organization Name:WILSHIRE IMAGING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:323-359-1279
Mailing Address - Street 1:6300 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5204
Mailing Address - Country:US
Mailing Address - Phone:323-655-0363
Mailing Address - Fax:323-655-0349
Practice Address - Street 1:6300 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5204
Practice Address - Country:US
Practice Address - Phone:323-655-0363
Practice Address - Fax:323-655-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty