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General NPI Number Information
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NPI Number | 1114971629
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Entity Type | Organization
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Legal Business Name | USC IMAGING ASSOCIATES INC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 1744 ZONAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-5318
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Country | US
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Telephone | 323-221-2744
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Fax | 323-221-1934
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Provider Business Mailing Address
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Address Line | FILE 57174
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone | 323-221-2744
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD GRANT
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Credential | M.D.
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Telephone | 323-221-2744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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