Basic Information
| Provider Information | |||||||||
| NPI: | 1063687648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED MEDICAL RADIOLOGY NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1762 WESTWOOD BLVD | ||||||||
| Address2: | # 230 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104742288 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15825 LAGUNA CANYON RD | ||||||||
| Address2: | # 101 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926182125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497779000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEIKALI | ||||||||
| AuthorizedOfficialFirstName: | MOOSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3104742288 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.