| NPI | 1104127505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL G WEISSBUCH Owner 818-955-9902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: CA A23457) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2010-11-16 |