Organization
GARDENA RADIOLOGY MEDICAL GROUP
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. JOHN N. LOIZEAUX-WITTE M.D. (CEO)
(310) 836-1574
Entity
Organization
Contact information
Practice address
1145 W REDONDO BEACH BLVD, GARDENA, CA 90247-3511
(310) 836-1574
Mailing address
PO BOX 17959, LOS ANGELES, CA 90017-0959
(213) 481-0584
(213) 481-0108
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017071
—
CA
Enumeration date
09/05/2007
Last updated
04/24/2008
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