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General NPI Number Information
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NPI Number | 1104106012
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Entity Type | Organization
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Legal Business Name | GLENDORA RADIOLOGICAL ASSOCIATES INC
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 414 E SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91723-1704
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Country | US
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Telephone | 626-339-5464
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Fax | 626-331-2328
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Provider Business Mailing Address
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Address Line | PO BOX 5010
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City | GLENDORA
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State | CA
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Zip | 91740-0735
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Country | US
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Telephone | 626-339-5464
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Fax | 626-331-2328
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | CATHY MARTINEZ
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Credential |
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Telephone | 626-339-5464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A112453
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License Number State | CA
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