Provider Demographics
NPI:1356970529
Name:SALEH MEDICAL RADIOLOGY AND ENDOVASCULAR
Entity type:Organization
Organization Name:SALEH MEDICAL RADIOLOGY AND ENDOVASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-918-3286
Mailing Address - Street 1:12339 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11760 CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1909
Practice Address - Country:US
Practice Address - Phone:601-918-3286
Practice Address - Fax:909-517-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty