1861905432 NPI number — LOS ROBLES RADIOLOGIC ASSOCIATES

Table of content: (NPI 1861905432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861905432 NPI number — LOS ROBLES RADIOLOGIC ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ROBLES RADIOLOGIC ASSOCIATES
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861905432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT LA 21628
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91185-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9712 W BEXHILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENSINGTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20895-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-455-4009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
805-496-5232

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)





Copyright © 2007-2025 www.npivalidator.com