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General NPI Number Information
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NPI Number | 1720042062
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Entity Type | Organization
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Legal Business Name | CROWN VALLEY RADIOLOGISTS INC A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 27401 LOS ALTOS STE 150
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8013
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Country | US
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Telephone | 949-367-1010
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Fax | 949-367-1011
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Provider Business Mailing Address
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Address Line | 27401 LOS ALTOS STE 150
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8013
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Country | US
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Telephone | 949-367-1010
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Fax | 949-367-1011
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TALAL BEYDOUN
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Credential | MD
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Telephone | 949-367-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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