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General NPI Number Information
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NPI Number | 1639122757
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Entity Type | Organization
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Legal Business Name | ROLLING OAKS RADIOLOGY MEDICAL CORP CORPORATION
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 415 ROLLING OAKS DR
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-1029
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Country | US
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Telephone | 805-778-1513
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 S WESTLAKE BLVD STE 14 PMB 114
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3133
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Country | US
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Telephone | 805-778-1513
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Fax | 805-267-5115
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ROBERT PRINCENTHAL
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Credential | M.D.
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Telephone | 805-778-1513
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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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