MEDICARE: RG DIAGNOSTIC, INC

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	:	1710168448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RG DIAGNOSTIC, INC

Provider Business Mailing Address
First Line	:	6363 WILSHIRE BLVD
Second Line	:	SUITE 516
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5701
Country	:	US
Telephone Number	:	323-655-9877
Fax Number	:	323-655-5199

Provider Business Practice Location Address
First Line	:	6363 WILSHIRE BLVD
Second Line	:	SUITE 516
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5701
Country	:	US
Telephone Number	:	323-655-9877
Fax Number	:	323-655-5199

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEX GAMARNIK
Credential	:
Telephone Number	:	323-655-9877

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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Directions to “RG DIAGNOSTIC, INC ” Practice Location

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