Provider Demographics
NPI:1134501257
Name:GROLIRA GROUP INC.
Entity type:Organization
Organization Name:GROLIRA GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-250-7620
Mailing Address - Street 1:4740 MURPHY CANYON ROAD SUITE # 205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:619-697-1111
Mailing Address - Fax:858-750-3441
Practice Address - Street 1:4740 MURPHY CANYON ROAD SUITE # 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:619-697-1111
Practice Address - Fax:858-750-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3697323261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile