Basic Information
| Provider Information | |||||||||
| NPI: | 1609185867 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | F & M RADIOLOGY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20011 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913642573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187086163 | ||||||||
| FaxNumber: | 8183405537 | ||||||||
| Practice Location | |||||||||
| Address1: | 20011 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913642573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187086163 | ||||||||
| FaxNumber: | 8183405537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 11/02/2017 | ||||||||
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| AuthorizedOfficialLastName: | TABIBIAN | ||||||||
| AuthorizedOfficialFirstName: | BAHRAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8187086163 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | F & M RADIOLOGY MEDICAL CENTER | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.