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General NPI Number Information
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NPI Number | 1801397377
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA ADVANCED DIAGNOSTIC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD STE 403
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City | ENCINO
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State | CA
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Zip | 91436-1959
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Country | US
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Telephone | 818-646-0118
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Fax | 818-532-6545
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Provider Business Mailing Address
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Address Line | 16661 VENTURA BLVD STE 403
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City | ENCINO
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State | CA
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Zip | 91436-1959
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Country | US
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Telephone | 818-646-0118
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Fax | 818-532-6545
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMAD AGHVAMI
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Credential |
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Telephone | 181-864-6011
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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 |
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License Number State |
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