Healthcare Provider Details

I. General information

NPI: 1710931381
Provider Name (Legal Business Name): BEVERLY RADIOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44305 LORIMER AVE
LANCASTER CA
93534-3700
US

IV. Provider business mailing address

PO BOX 240086
LOS ANGELES CA
90024-9186
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-8642
  • Fax: 661-940-1580
Mailing address:
  • Phone: 310-445-2800
  • Fax: 310-445-2816

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: HOWARD G BERGER
Title or Position: PRESIDENT
Credential: MD
Phone: 310-445-2800