Healthcare Provider Details

I. General information

NPI: 1326908740
Provider Name (Legal Business Name): RIVERSIDE DIAGNOSTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 WOODMAN AVE STE 300
SHERMAN OAKS CA
91423-2406
US

IV. Provider business mailing address

4730 WOODMAN AVE STE 300
SHERMAN OAKS CA
91423-2406
US

V. Phone/Fax

Practice location:
  • Phone: 747-208-8988
  • Fax: 747-247-2067
Mailing address:
  • Phone: 747-208-8988
  • Fax: 747-247-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN MORALES
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 747-208-8988