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General NPI Number Information
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NPI Number | 1831633080
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Entity Type | Organization
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Legal Business Name | GLENDORA RADIOLOGICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 210 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91723-1515
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Country | US
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Telephone | 626-339-5464
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Fax |
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Provider Business Mailing Address
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Address Line | 414 E SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91723-1704
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Country | US
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Telephone | 626-339-5464
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID JOSEPH UNDERWOOD
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Credential | MD
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Telephone | 626-339-5464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A129256
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License Number State | CA
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