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General NPI Number Information
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NPI Number | 1396759726
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Entity Type | Organization
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Legal Business Name | GLENDALE RADIOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1509 WILSON TER 1420 S CENTRAL AVE
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City | GLENDALE
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State | CA
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Zip | 91206-4007
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Country | US
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Telephone | 818-247-2095
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Fax | 818-247-1863
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Provider Business Mailing Address
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Address Line | 625 N MARYLAND AVE
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City | GLENDALE
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State | CA
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Zip | 91206-2245
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Country | US
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Telephone | 818-247-2095
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Fax | 818-247-1863
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES M. LILLEY
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Credential | M.D.
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Telephone | 818-247-2095
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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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