Provider Demographics
NPI:1851682595
Name:BROADWAY RADIOLOGY, INC.
Entity Type:Organization
Organization Name:BROADWAY RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:CERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-231-5044
Mailing Address - Street 1:231 W VERNON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2778
Mailing Address - Country:US
Mailing Address - Phone:323-231-5044
Mailing Address - Fax:323-231-5362
Practice Address - Street 1:231 W VERNON AVE STE 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2778
Practice Address - Country:US
Practice Address - Phone:323-231-5044
Practice Address - Fax:323-231-5362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology