Provider Demographics
NPI:1891042123
Name:F&M RADIOLOGY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:F&M RADIOLOGY MEDICAL CENTER INC
Other - Org Name:UNITED SLEEP LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOOSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIKALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-6163
Mailing Address - Street 1:18065 VENTURA BLVD
Mailing Address - Street 2:ENCINO
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3517
Mailing Address - Country:US
Mailing Address - Phone:818-708-6163
Mailing Address - Fax:818-344-1390
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:226
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-849-5903
Practice Address - Fax:818-776-1069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:F&M RADIOLOGY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
204D00000X
CAA405592084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty