Provider Demographics
NPI:1801397377
Name:SOUTHERN CALIFORNIA ADVANCED DIAGNOSTIC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA ADVANCED DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHVAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:181-864-6011
Mailing Address - Street 1:16661 VENTURA BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1959
Mailing Address - Country:US
Mailing Address - Phone:818-646-0118
Mailing Address - Fax:818-532-6545
Practice Address - Street 1:16661 VENTURA BLVD STE 403
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1959
Practice Address - Country:US
Practice Address - Phone:818-646-0118
Practice Address - Fax:818-532-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology