Basic Information
| Provider Information | |||||||||
| NPI: | 1104106012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLENDORA RADIOLOGICAL ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5010 | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917400735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263395464 | ||||||||
| FaxNumber: | 6263312328 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 E SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917231704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263395464 | ||||||||
| FaxNumber: | 6263312328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2011 | ||||||||
| LastUpdateDate: | 08/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6263395464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | A112453 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.