Healthcare Provider Details

I. General information

NPI: 1639349814
Provider Name (Legal Business Name): GLENDALE MEDICAL IMAGING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MARYLAND AVE SUITE 100
GLENDALE CA
91206-4262
US

IV. Provider business mailing address

200 N MARYLAND AVE SUITE 100
GLENDALE CA
91206-4262
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-2095
  • Fax: 818-241-7278
Mailing address:
  • Phone: 818-247-2095
  • Fax: 818-241-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES LILLEY
Title or Position: PRESIDENT/RADIOLOGIST
Credential: M.D.
Phone: 818-247-2095