MEDICARE: EMPIRE RADIOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1073855748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE RADIOLOGY, LLC

Provider Business Mailing Address
First Line	:	14622 VENTURA BLVD
Second Line	:	725
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3600
Country	:	US
Telephone Number	:	951-263-7842
Fax Number	:

Provider Business Practice Location Address
First Line	:	11801 PIERCE ST
Second Line	:	200
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-4408
Country	:	US
Telephone Number	:	951-263-7842
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATT SABKRHANI
Credential	:
Telephone Number	:	818-294-7266

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	04/23/2015

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