Healthcare Provider Details

I. General information

NPI: 1891042123
Provider Name (Legal Business Name): F&M RADIOLOGY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD 226
ENCINO CA
91436-1914
US

IV. Provider business mailing address

18065 VENTURA BLVD ENCINO
ENCINO CA
91316-3517
US

V. Phone/Fax

Practice location:
  • Phone: 818-849-5903
  • Fax: 818-776-1069
Mailing address:
  • Phone: 818-708-6163
  • Fax: 818-344-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA40559
License Number StateCA

VIII. Authorized Official

Name: DR. MOOSSA HEIKALI
Title or Position: OWNER/MEDICAL DIRECTOR/CEO
Credential: M.D
Phone: 818-708-6163