Healthcare Provider Details

I. General information

NPI: 1003074725
Provider Name (Legal Business Name): INTERVENTIONAL RADIOLOGY COVERAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE SUITE 104
SAN JOSE CA
95128-1811
US

IV. Provider business mailing address

105 N BASCOM AVE SUITE 104
SAN JOSE CA
95128-1811
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-0405
  • Fax: 408-918-0409
Mailing address:
  • Phone: 408-918-0405
  • Fax: 408-918-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC2978113
License Number StateCA

VIII. Authorized Official

Name: REZA MALEK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-918-0405