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General NPI Number Information
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NPI Number | 1538399555
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Entity Type | Organization
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Legal Business Name | SAN FERNANDO DIAGNOSTIC AND IMAGING, INC
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 211 S MACLAY AVE
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City | SAN FERNANDO
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State | CA
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Zip | 91340-3603
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Country | US
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Telephone | 818-408-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 16060 VENTURA BLVD STE 105-338
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City | ENCINO
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State | CA
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Zip | 91436-2761
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Country | US
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Telephone | 818-361-5269
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Fax | 818-837-7291
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Authorized Official
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Title or Position | CEO
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Name | ROBERT L WILSON
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Credential | M.D.
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Telephone | 818-361-5269
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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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