Healthcare Provider Details

I. General information

NPI: 1619216132
Provider Name (Legal Business Name): TOWER IMAGING MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23929 MCBEAN PKWY BUILDING F - SUITE 109
VALENCIA CA
91355-4466
US

IV. Provider business mailing address

5455 WILSHIRE BLVD SUITE 1120
LOS ANGELES CA
90036-4201
US

V. Phone/Fax

Practice location:
  • Phone: 661-753-5400
  • Fax: 661-753-5401
Mailing address:
  • Phone: 323-549-3030
  • Fax: 323-549-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD MICHAEL ROTH
Title or Position: PRESIDENT
Credential: MD
Phone: 323-549-3030