=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700258423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVERY RADIOLOGY PHYSICIANS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2015
-----------------------------------------------------
Last Update Date | 12/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7111 WINNETKA AVE #16
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91306-3672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-337-3550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CENTERPOINTE DR 700
-----------------------------------------------------
City | LA PALMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90623-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-254-3242
-----------------------------------------------------
Fax | 657-500-4225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AMJAD SAFVI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 657-254-3242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------