Organization
ST VINCENT RADIOLOGICAL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR WALUCH M.D. (CFO)
(213) 484-7901
Entity
Organization
Contact information
Practice address
2131 W 3RD ST, LOS ANGELES, CA 90057-1901
(213) 484-7901
(213) 353-0325
Mailing address
PO BOX 19130, NEWBURY PARK, CA 91319-9130
(213) 484-7901
(213) 353-0325
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ77454Z
—
CA
Enumeration date
06/24/2008
Last updated
08/26/2008
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