Basic Information
| Provider Information | |||||||||
| NPI: | 1134759111 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED MEDICAL RADIOLOGY NETWORK, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 491149 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900499149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109438400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 624 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912042009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182413369 | ||||||||
| FaxNumber: | 8184852213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2020 | ||||||||
| LastUpdateDate: | 01/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZARIAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3109438400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.