MEDICARE: ROLLING OAKS RADIOLOGY MEDICAL CORP CORPORATION

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CG2342	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	ZZZ39119Z	OTHER	BLUE SHIELD
2	ZZZ65592Z	OTHER	BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639122757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROLLING OAKS RADIOLOGY MEDICAL CORP CORPORATION

Provider Business Mailing Address
First Line	:	1014 S WESTLAKE BLVD STE 14
Second Line	:	PMB 114
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-3133
Country	:	US
Telephone Number	:	805-778-1513
Fax Number	:	805-267-5115

Provider Business Practice Location Address
First Line	:	415 ROLLING OAKS DR
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91361-1029
Country	:	US
Telephone Number	:	805-778-1513
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ROBERT PRINCENTHAL
Credential	:	M.D.
Telephone Number	:	805-778-1513

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	02/07/2013

Similar Medicare Providers

1881665586 — DR. GLENN ERIC WALDMAN M.D.
Practice Location Address:

415 ROLLING OAKS DR , SUITE 190
THOUSAND OAKS, CA
91361-1029

Practice Phone: 805-494-4797
Practice Fax: 805-494-4810

1629015474 — DR. KRISTIN JEAN SANTANGELO M.D.
Practice Location Address:

415 ROLLING OAKS DR , SUITE 260
THOUSAND OAKS, CA
91361-1029

Practice Phone: 805-371-3770
Practice Fax: 805-371-4714

1558385922 — DR. MOJGAN HASHEMI D.D.S.
Practice Location Address:

415 EAST ROLLING OAKS DR , SUITE 120
THOUSAND OAKS, CA
91361-1029

Practice Phone: 805-449-9952
Practice Fax: 805-449-1189

1134232457 — DR. LOUISE GARCIA M.D.
Practice Location Address:

415 ROLLING OAKS DR , SUITE 200
THOUSAND OAKS, CA
91361-1029

Practice Phone: 805-777-7009
Practice Fax: 805-777-7686

1053417865 — MICHAEL T MOSHER M.D.
Practice Location Address:

415 ROLLING OAKS DR , SUITE 280
THOUSAND OAKS, CA
91361-1029

Practice Phone: 805-496-8522
Practice Fax: 805-496-0469

1497820930 — CLYDE KNOBLAUCH JR. DDS
Practice Location Address:

415 ROLLING OAKS DR , #215
THOUSAND OAKS, CA
91361-1029

Practice Phone: 805-496-2456
Practice Fax:

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