MEDICARE: RADGISTICS

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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1225526981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADGISTICS

Provider Business Mailing Address
First Line	:	11755 VICTORY BLVD STE 108
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3461
Country	:	US
Telephone Number	:	818-853-7240
Fax Number	:	818-853-7241

Provider Business Practice Location Address
First Line	:	11755 VICTORY BLVD STE 108
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3461
Country	:	US
Telephone Number	:	818-853-7240
Fax Number	:	818-853-7241

Authorized Official
Title or Position	:	CEO
Name	:	RAISA AYTAYAN
Credential	:
Telephone Number	:	818-853-7240

Provider Enumeration Date	:	04/28/2018
Last Update Date	:	05/09/2018

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