Healthcare Provider Details

I. General information

NPI: 1912126905
Provider Name (Legal Business Name): SHERMAN OAKS DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 VAN NUYS BLVD
SHERMAN OAKS CA
91403-1702
US

IV. Provider business mailing address

25020 AVENUE STANFORD SUITE 50
VALENCIA CA
91355-3430
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-4530
  • Fax: 818-907-2873
Mailing address:
  • Phone: 661-295-0260
  • Fax: 661-295-8518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MARK AGULNEK
Title or Position: OFFICER
Credential: M.D.
Phone: 818-981-7111