Basic Information
| Provider Information | |||||||||
| NPI: | 1134568033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED MEDICAL RADIOLOGY NETWORK | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UMRN OF CENTURY CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 491160 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900499160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104742288 | ||||||||
| FaxNumber: | 3109239912 | ||||||||
| Practice Location | |||||||||
| Address1: | 2080 CENTURY PARK E | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CENTURY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900672001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104742288 | ||||||||
| FaxNumber: | 3109239912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2013 | ||||||||
| LastUpdateDate: | 06/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | HEIKALI | ||||||||
| AuthorizedOfficialFirstName: | MOOSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3104742288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.