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Organization
UCLA RADIOLOGY MEDICAL GROUP
Active
Organization
UCLA RADIOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIETER ENZMANN (DEPARTMENT CHAIRMAN)
(310) 794-6624
Entity
Organization
Contact information
Practice address
757 WESTWOOD PLZ, LOS ANGELES, CA 90095-3075
(310) 825-9111
Mailing address
FILE 55619, LOS ANGELES, CA 90074-0001
(310) 825-4721
(310) 301-8751
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0053540
—
CA
05
—
GR0053541
—
CA
Enumeration date
12/19/2005
Last updated
12/04/2020
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