Healthcare Provider Details

I. General information

NPI: 1972938876
Provider Name (Legal Business Name): SONIC RADIOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23148 PARK CONTESSA
CALABASAS CA
91302-1709
US

IV. Provider business mailing address

23148 PARK CONTESSA
CALABASAS CA
91302-1709
US

V. Phone/Fax

Practice location:
  • Phone: 818-300-7885
  • Fax: 818-222-2360
Mailing address:
  • Phone: 818-300-7885
  • Fax: 818-222-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberRHF00066355
License Number StateCA

VIII. Authorized Official

Name: HAMID KOUROSHY
Title or Position: CEO
Credential: RT
Phone: 818-300-7885