Healthcare Provider Details

I. General information

NPI: 1790956308
Provider Name (Legal Business Name): F&M RADIOLOGY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2008
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18065 VENTURA BLVD
ENCINO CA
91316-3517
US

IV. Provider business mailing address

PO BOX 49911
LOS ANGELES CA
90049-0911
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-6163
  • Fax: 818-344-1390
Mailing address:
  • Phone: 818-708-6163
  • Fax: 818-344-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: BAHRAM TABIBIAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-708-6163