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General NPI Number Information
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NPI Number | 1639349814
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Entity Type | Organization
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Legal Business Name | GLENDALE MEDICAL IMAGING ASSOCIATES INC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 200 N MARYLAND AVE SUITE 100
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City | GLENDALE
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State | CA
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Zip | 91206-4262
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Country | US
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Telephone | 818-247-2095
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Fax | 818-241-7278
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Provider Business Mailing Address
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Address Line | 200 N MARYLAND AVE SUITE 100
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City | GLENDALE
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State | CA
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Zip | 91206-4262
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Country | US
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Telephone | 818-247-2095
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Fax | 818-241-7278
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Authorized Official
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Title or Position | PRESIDENT/RADIOLOGIST
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Name | JAMES 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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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