MEDICARE: I V RADIOLOGY MEDICAL GROUP

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

General Provider Information

NPI Number	:	1740721661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I V RADIOLOGY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91319-0009
Country	:	US
Telephone Number	:	559-455-4009
Fax Number	:	916-533-0313

Provider Business Practice Location Address
First Line	:	162 VIA MONTE DORO
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6440
Country	:	US
Telephone Number	:	559-455-4009
Fax Number	:	916-533-0313

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. RAMON O PASCUAL
Credential	:	MD
Telephone Number	:	559-455-4009

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	03/24/2021

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