1629058466 NPI number — THOUSAND OAKS DIAGNOSTIC IMAGING CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629058466 NPI number — THOUSAND OAKS DIAGNOSTIC IMAGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOUSAND OAKS DIAGNOSTIC IMAGING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THOUSAND OAKS RADIOLOGY GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629058466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90051-5338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-210-0857
Provider Business Mailing Address Fax Number:
805-375-8903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 WEST JANSS ROAD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-496-7755
Provider Business Practice Location Address Fax Number:
805-495-0023
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
805-496-7755

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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