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General NPI Number Information
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NPI Number | 1134501257
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Entity Type | Organization
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Legal Business Name | GROLIRA GROUP INC.
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 4740 MURPHY CANYON ROAD SUITE # 205
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 619-697-1111
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Fax | 858-750-3441
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Provider Business Mailing Address
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Address Line | 4740 MURPHY CANYON ROAD SUITE # 205
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 619-697-1111
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Fax | 858-750-3441
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. KAVEH KHAST
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Credential |
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Telephone | 619-250-7620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | C3697323
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License Number State | CA
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