Organization
GOLDEN WEST RADIOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA GARCIA (CREDENTIALING SPECIALIST)
(805) 375-8823
Entity
Organization
Contact information
Practice address
1111 WEST LA PALMA AVE, ANAHEIM, CA 92801-2804
(714) 999-6080
(714) 999-3924
Mailing address
PO BOX 19070, NEWBURY PARK, CA 91319-9070
(800) 318-6347
(805) 375-8903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HSC30226F
MCAL IP FACILITY ID
CA
01
—
ZZT40226F
MCAL OP FACILITY ID
CA
05
—
ZZZ77487Z
—
CA
Enumeration date
11/29/2006
Last updated
07/16/2019
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