Provider Demographics
NPI:1972550598
Name:GERALD BRIAN CRUMLEY
Entity Type:Organization
Organization Name:GERALD BRIAN CRUMLEY
Other - Org Name:WARNER RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CRUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:818-347-0348
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:104
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2006
Mailing Address - Country:US
Mailing Address - Phone:818-347-0348
Mailing Address - Fax:818-347-0450
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:104
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-347-0348
Practice Address - Fax:818-347-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0200X261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD034Medicare ID - Type Unspecified