Healthcare Provider Details

I. General information

NPI: 1457300493
Provider Name (Legal Business Name): WHITTIER RADIOLOCAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 COLIMA RD DEPARTMENT OF RADIOLOGY
WHITTIER CA
90605-1600
US

IV. Provider business mailing address

LOCK BOX 50164
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 562-907-1660
  • Fax: 714-443-5763
Mailing address:
  • Phone: 714-443-5959
  • Fax: 714-443-5763

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 Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAXIMINO BASCO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-907-1660