MEDICARE: MRI HEALTHCARE CENTER OF GLENDALE

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	2085R0202X	Diagnostic Radiology Physician	G206170	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275612509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MRI HEALTHCARE CENTER OF GLENDALE

Provider Business Mailing Address
First Line	:	1056 TYLER LN
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-9279
Country	:	US
Telephone Number	:	909-982-2985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2212
Country	:	US
Telephone Number	:	818-244-4646
Fax Number	:

Authorized Official
Title or Position	:	RADIOLOGISTMEDICAL DIRECTOR
Name	:	DR. SEVERIANO VALENZUELA
Credential	:	M.D.
Telephone Number	:	818-244-4646

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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Directions to “MRI HEALTHCARE CENTER OF GLENDALE ” Practice Location

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