Provider Demographics
NPI:1770722837
Name:THOUSAND OAKS DIAGNOSTIC IMAGING CENTER
Entity type:Organization
Organization Name:THOUSAND OAKS DIAGNOSTIC IMAGING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEVIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TURKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-7755
Mailing Address - Street 1:2190 LYNN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1980
Mailing Address - Country:US
Mailing Address - Phone:805-495-8050
Mailing Address - Fax:805-496-2160
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-496-7755
Practice Address - Fax:805-379-3913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOUSAND OAKS DIAGNOSTIC IMAGING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-13
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATP118AMedicare PIN
TP118Medicare PIN