Basic Information
| Provider Information | |||||||||
| NPI: | 1720625742 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | F&M RADIOLOGY MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20011 VENTURA BLVD # 1002 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913642573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187086163 | ||||||||
| FaxNumber: | 8183405537 | ||||||||
| Practice Location | |||||||||
| Address1: | 17779 VENTURA BLVD # 100 | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913163717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187086163 | ||||||||
| FaxNumber: | 8183405537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2019 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | SALARI | ||||||||
| AuthorizedOfficialFirstName: | RAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8187086163 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | F&M RADIOLOGY MEDICAL CENTER INC | ||||||||
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| AuthorizedOfficialCredential: | M.D, | ||||||||
| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.