1427002856 NPI number — HAWTHORNE RADIOLOGY ASSOCIATES MEDICAL GROUP, INC.

Table of content: (NPI 1427002856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427002856 NPI number — HAWTHORNE RADIOLOGY ASSOCIATES MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWTHORNE RADIOLOGY ASSOCIATES MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1427002856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93062-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-522-5940
Provider Business Mailing Address Fax Number:
805-522-6401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1918 W BEVERLY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-965-0483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
SIDNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
323-932-5301

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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