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General NPI Number Information
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NPI Number | 1104127505
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Entity Type | Organization
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Legal Business Name | R G W MULTI SPECIALTY MEDICAL GROUP INC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 1915 W GLENOAKS BLVD SUITE 101
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City | GLENDALE
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State | CA
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Zip | 91201-1541
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Country | US
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Telephone | 818-955-9902
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Fax | 818-955-9987
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Provider Business Mailing Address
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Address Line | 1915 W GLENOAKS BLVD SUITE 101
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City | GLENDALE
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State | CA
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Zip | 91201-1541
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Country | US
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Telephone | 818-955-9902
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Fax | 818-955-9987
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL G WEISSBUCH
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Credential | M.D.
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Telephone | 818-955-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | A23457
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License Number State | CA
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