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Organization
WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUP, INC.
Active
Organization
WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUP, INC.
Active
Other names
Western Radiologic Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN N. LOIZEAUX-WITTE M.D. (PRESIDENT)
(310) 836-1574
Entity
Organization
Contact information
Practice address
4640 ADMIRALTY WAY, SUITE 102, MARINA DEL REY, CA 90292-6621
(310) 836-1574
(310) 836-6925
Mailing address
4640 ADMIRALTY WAY, SUITE 102, MARINA DEL REY, CA 90292-6621
(310) 836-1574
(310) 836-6925
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017071
—
CA
05
—
GR0017072
—
CA
05
—
GR0017076
—
CA
Enumeration date
10/02/2006
Last updated
06/14/2012
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