Healthcare Provider Details

I. General information

NPI: 1679689244
Provider Name (Legal Business Name): OAKS DIAGNOSTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD SUITE 105
BEVERLY HILLS CA
90211-2900
US

IV. Provider business mailing address

8641 WILSHIRE BLVD SUITE 105
BEVERLY HILLS CA
90211-2900
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-8678
  • Fax: 310-289-1161
Mailing address:
  • Phone: 310-289-8678
  • Fax: 310-289-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD SELWYN GRUSD
Title or Position: RADIOLOGIST
Credential: M.D.
Phone: 310-289-8678