Organization
SHICARE RADIOLOGY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI R RAVAI (CFO)
(877) 922-5111
Entity
Organization
Contact information
Practice address
5535 BALBOA BLVD., SUITE 227, ENCINO, CA 91316-1516
(877) 922-5111
(310) 715-8245
Mailing address
5535 BALBOA BLVD., SUITE 227, ENCINO, CA 91316-1516
(877) 922-5111
(310) 715-8245
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A33257
STATE LICENCE
CA
Enumeration date
11/13/2007
Last updated
10/16/2019
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