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General NPI Number Information
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NPI Number | 1164564597
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Entity Type | Organization
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Legal Business Name | VENTURA IMAGING AND RADIOLOGY CENTER
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD SUITE # 787
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City | ENCINO
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State | CA
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Zip | 91436-2124
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Country | US
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Telephone | 818-905-7323
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Fax | 818-783-6108
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Provider Business Mailing Address
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Address Line | 16311 VENTURA BLVD SUITE # 787
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City | ENCINO
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State | CA
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Zip | 91436-2124
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Country | US
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Telephone | 818-905-7323
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Fax | 818-783-6108
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HEDAYAT ED GOLCHEH
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Credential | M.D.
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Telephone | 818-905-7323
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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 | A040588
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License Number State | CA
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