MEDICARE: CORE ANALYTICS 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	261QR0208X	Mobile Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73700	OTHER	CA	CDPH

General Provider Information

NPI Number	:	1356779029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE ANALYTICS RADIOLOGY, LLC

Provider Business Mailing Address
First Line	:	14735 CALIFA ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-3107
Country	:	US
Telephone Number	:	818-906-2614
Fax Number	:

Provider Business Practice Location Address
First Line	:	14735 CALIFA ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-3107
Country	:	US
Telephone Number	:	818-906-2614
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CARLOS RUIZ
Credential	:
Telephone Number	:	818-906-2614

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	01/21/2026

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