MEDICARE: TUAZON RADIOLOGY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center	RHF83273	CA

General Provider Information

NPI Number	:	1518262906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUAZON RADIOLOGY SERVICES

Provider Business Mailing Address
First Line	:	6526 PETERSON AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-3145
Country	:	US
Telephone Number	:	818-268-7593
Fax Number	:

Provider Business Practice Location Address
First Line	:	6526 PETERSON AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-3145
Country	:	US
Telephone Number	:	818-268-7593
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. RENATO APULI TUAZON
Credential	:	(R) ARRT
Telephone Number	:	818-268-7593

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	01/17/2011

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