Basic Information
| Provider Information | |||||||||
| NPI: | 1811228026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | F&M RADIOLOGY MEDICAL CENTER INC | ||||||||
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| OtherOrganizationName: | SANBERNARDINO OPEN MRI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20011 VENTURA BLVD | ||||||||
| Address2: | 1002 | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187086163 | ||||||||
| FaxNumber: | 8183405537 | ||||||||
| Practice Location | |||||||||
| Address1: | 1884 BUSINESS CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098905552 | ||||||||
| FaxNumber: | 9098905588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 09/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | TABIBIAN | ||||||||
| AuthorizedOfficialFirstName: | BAHRAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8187086163 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | F&M RADIOLOGY MEDICAL CENTER INC | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0208X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.