Provider Demographics
NPI:1457300493
Name:WHITTIER RADIOLOCAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:WHITTIER RADIOLOCAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIMINO
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-907-1660
Mailing Address - Street 1:LOCK BOX 50164
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:714-443-5959
Mailing Address - Fax:714-443-5763
Practice Address - Street 1:9080 COLIMA RD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1600
Practice Address - Country:US
Practice Address - Phone:562-907-1660
Practice Address - Fax:714-443-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64837ZOtherBLUE SHIELD GROUP
CAGR0099770Medicaid
CAZZZ64837ZOtherBLUE SHIELD GROUP