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General NPI Number Information
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NPI Number | 1710337357
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Entity Type | Organization
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Legal Business Name | BURBANK IMAGING AND OPEN MRI INC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 333 E MAGNOLIA BLVD STE 104 #104
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City | BURBANK
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State | CA
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Zip | 91502-1198
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Country | US
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Telephone | 818-478-8060
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Fax | 818-478-2960
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Provider Business Mailing Address
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Address Line | 333 E MAGNOLIA BLVD STE 104 #104
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City | BURBANK
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State | CA
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Zip | 91502-1198
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Country | US
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Telephone |
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Fax | 818-478-2960
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Authorized Official
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Title or Position | CEO
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Name | MR. NICKY GOLBAHAR
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Credential |
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Telephone | 818-478-8060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | BT-1011543
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License Number State | CA
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