MEDICARE: WESTCOM 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ52740Z	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912968231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCOM RADIOLOGY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 10076
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91410-0076
Country	:	US
Telephone Number	:	805-578-8300
Fax Number	:	805-578-8950

Provider Business Practice Location Address
First Line	:	6245 DE LONGPRE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-8253
Country	:	US
Telephone Number	:	323-462-2271
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARTIN A SCHWARTZ
Credential	:	MD
Telephone Number	:	323-462-2271

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	11/16/2009

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