Healthcare Provider Details

I. General information

NPI: 1801907084
Provider Name (Legal Business Name): LIBERTY PACIFIC MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16130 VENTURA BLVD SUITE #100
ENCINO CA
91436-2503
US

IV. Provider business mailing address

16130 VENTURA BLVD SUITE #100
ENCINO CA
91436-2503
US

V. Phone/Fax

Practice location:
  • Phone: 818-933-2020
  • Fax: 818-933-2021
Mailing address:
  • Phone: 818-933-2020
  • Fax: 818-933-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE KAVON
Title or Position: V.P. MARKETING & PAYER CONTRACTING
Credential:
Phone: 530-367-5295