Healthcare Provider Details

I. General information

NPI: 1114971629
Provider Name (Legal Business Name): USC IMAGING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 ZONAL AVE
LOS ANGELES CA
90033-5318
US

IV. Provider business mailing address

FILE 57174
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-2744
  • Fax: 323-221-1934
Mailing address:
  • Phone: 323-221-2744
  • Fax:

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: DR. EDWARD GRANT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-221-2744