Basic Information
Provider Information | |||||||||
NPI: | 1396132254 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNITED MEDICAL RADIOLOGY NETWORK | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | UMRN OF CENTRAL LONG BEACH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 491160 | ||||||||
Address2: |   | ||||||||
City: | LOS ANGELES | ||||||||
State: | CA | ||||||||
PostalCode: | 900499160 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3104742288 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 701 E 28TH ST | ||||||||
Address2: | SUITE 318 | ||||||||
City: | LONG BEACH | ||||||||
State: | CA | ||||||||
PostalCode: | 908062759 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5624267000 | ||||||||
FaxNumber: | 5624267099 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2015 | ||||||||
LastUpdateDate: | 04/17/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZARIAN | ||||||||
AuthorizedOfficialFirstName: | DAVID | ||||||||
AuthorizedOfficialMiddleName: | H | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/MEDICAL DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3104742288 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0206X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography |
No ID Information.