Provider Demographics
NPI:1265554224
Name:SAND CANYON RADIOLOGY, INC.
Entity type:Organization
Organization Name:SAND CANYON RADIOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LASZLO
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAVEGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-6055
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3711
Mailing Address - Country:US
Mailing Address - Phone:949-753-0900
Mailing Address - Fax:949-753-1719
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-753-0900
Practice Address - Fax:949-753-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty