Basic Information
| Provider Information | |||||||||
| NPI: | 1285867887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEVERLY RADIOLOGY MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1516 COTNER AVE | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900253303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104452800 | ||||||||
| FaxNumber: | 5852416872 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 E MAIN ST | ||||||||
| Address2: | SUITES 213 & 214 | ||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923112361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602424444 | ||||||||
| FaxNumber: | 7602427288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2009 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | BERGER | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO & PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3104452800 | ||||||||
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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 | 23105 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.