Provider Demographics
NPI:1245286202
Name:VALLEY RADIOLOGY INC
Entity type:Organization
Organization Name:VALLEY RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:I
Authorized Official - Last Name:TSIMERINOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-776-9100
Mailing Address - Street 1:17779 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3717
Mailing Address - Country:US
Mailing Address - Phone:818-776-9100
Mailing Address - Fax:818-776-0544
Practice Address - Street 1:17779 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3717
Practice Address - Country:US
Practice Address - Phone:818-776-9100
Practice Address - Fax:818-776-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT379Medicare PIN