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General NPI Number Information
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NPI Number | 1972080356
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Entity Type | Organization
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Legal Business Name | LOS ALAMITOS RADIOLOGY GROUP INC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 3406 KILDARE CT
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City | BURBANK
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State | CA
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Zip | 91504-1665
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Country | US
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Telephone | 805-375-8804
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Fax | 770-237-1429
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Provider Business Mailing Address
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Address Line | PO BOX 650
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City | NEWBURY PARK
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State | CA
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Zip | 91319-0650
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Country | US
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Telephone | 805-375-8804
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Fax | 770-237-1429
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. VINCENT S. POLEK
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Credential | MD
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Telephone | 805-375-8804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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