Organization
WEST COAST RADIOLOGY CENTER - ANAHEIM
Active
Parent organization
WEST COAST RADIOLOGY, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST COAST RADIOLOGY, INC.
Authorized official
DR. MICHAEL L. BLACK M.D. (PRESIDENT)
(714) 835-6055
Entity
Organization
Contact information
Practice address
1085 N HARBOR BLVD, ANAHEIM, CA 92801-2417
(714) 300-0703
(714) 300-0704
Mailing address
1085 N HARBOR BLVD, ANAHEIM, CA 92801-2417
(714) 300-0703
(714) 300-0704
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W10646
MEDICARE PTAN
—
Enumeration date
07/22/2009
Last updated
07/28/2009
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