Healthcare Provider Details

I. General information

NPI: 1750614343
Provider Name (Legal Business Name): F&M RADIOLOGY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 SANTA MONICA BLVD STE 310
LOS ANGELES CA
90025-7558
US

IV. Provider business mailing address

PO BOX 49911
LOS ANGELES CA
90049-0911
US

V. Phone/Fax

Practice location:
  • Phone: 310-481-0858
  • Fax: 310-474-3416
Mailing address:
  • Phone: 818-708-6163
  • Fax: 818-344-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

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