Healthcare Provider Details

I. General information

NPI: 1184810277
Provider Name (Legal Business Name): RAD ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD MEZZANINE LEVEL
LOS ANGELES CA
90024-3906
US

IV. Provider business mailing address

PO BOX 29950
ANAHEIM CA
92809
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-9080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE WHITNEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 714-835-9080