Healthcare Provider Details

I. General information

NPI: 1457561938
Provider Name (Legal Business Name): SMYTH DRIVE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27879 SMYTH DR STE B
VALENCIA CA
91355-6065
US

IV. Provider business mailing address

27879 SMYTH DR STE B
VALENCIA CA
91355-6065
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-2500
  • Fax: 661-362-0230
Mailing address:
  • Phone: 661-259-2500
  • Fax: 661-362-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberRHC00164485
License Number StateCA

VIII. Authorized Official

Name: SATISH RAO VADAPALLI
Title or Position: PHYSIAN
Credential: M.D.
Phone: 661-259-2500