Basic Information
| Provider Information | |||||||||
| NPI: | 1003074725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERVENTIONAL RADIOLOGY COVERAGE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 N BASCOM AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951281811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089180405 | ||||||||
| FaxNumber: | 4089180409 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 N BASCOM AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951281811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089180405 | ||||||||
| FaxNumber: | 4089180409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | MALEK | ||||||||
| AuthorizedOfficialFirstName: | REZA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4089180405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C2978113 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.