Healthcare Provider Details

I. General information

NPI: 1154357531
Provider Name (Legal Business Name): SOUTH VALLEY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18344 CLARK ST SUITE 101
TARZANA CA
91356-3505
US

IV. Provider business mailing address

PO BOX 16699
IRVINE CA
92623-6699
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-9811
  • Fax:
Mailing address:
  • Phone: 818-881-9811
  • Fax: 818-881-1638

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 Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberNA
License Number State

VIII. Authorized Official

Name: MR. MICHAEL KYLE BURTNETT
Title or Position: SVP OF OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2153