Provider Demographics
NPI:1851531735
Name:RADIOGRAPHICA MEDICA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:RADIOGRAPHICA MEDICA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-724-1911
Mailing Address - Street 1:949 GOODRICH BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4116
Mailing Address - Country:US
Mailing Address - Phone:323-724-1911
Mailing Address - Fax:323-724-1946
Practice Address - Street 1:949 GOODRICH BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4116
Practice Address - Country:US
Practice Address - Phone:323-724-1911
Practice Address - Fax:323-724-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWC32260A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC32260AMedicare PIN