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Organization
WESTERN IMAGING, MARINA DEL REY
Active
Organization
WESTERN IMAGING, MARINA DEL REY
Active
Parent organization
WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUP
Authorized official
DR. MATTHEW J LOTYSCH M.D. (MEDICAL DIRECTOR)
31083964700
Entity
Organization
Contact information
Practice address
4640 ADMIRALTY WAY, SUITE 102, MARINA DEL REY, CA 90292-6621
(310) 836-4700
(310) 836-6925
Mailing address
9808 VENICE BLVD, 2ND FLOOR, CULVER CITY, CA 90232
(310) 836-4700
(310) 836-6925
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017072
—
CA
Enumeration date
10/04/2006
Last updated
08/30/2007
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