Provider Demographics
NPI:1821410382
Name:WEST VALLEY MRI INC
Entity Type:Organization
Organization Name:WEST VALLEY MRI INC
Other - Org Name:WEST VALLEY MRI INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMZELETOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-712-0021
Mailing Address - Street 1:20251 VENTURA BLVD
Mailing Address - Street 2:D
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2563
Mailing Address - Country:US
Mailing Address - Phone:818-712-0021
Mailing Address - Fax:818-712-0015
Practice Address - Street 1:20251 VENTURA BLVD
Practice Address - Street 2:D
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2563
Practice Address - Country:US
Practice Address - Phone:818-712-0021
Practice Address - Fax:818-712-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology