Provider Demographics
NPI:1700355013
Name:SOCAL IMAGING
Entity Type:Organization
Organization Name:SOCAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMZELETOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-402-2831
Mailing Address - Street 1:3760 SANTA ROSALIA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3611
Mailing Address - Country:US
Mailing Address - Phone:888-814-0206
Mailing Address - Fax:
Practice Address - Street 1:3760 SANTA ROSALIA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3611
Practice Address - Country:US
Practice Address - Phone:888-814-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier