Organization
GLENDALE RADIOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES M. LILLEY M.D. (PRESIDENT)
(818) 247-2095
Entity
Organization
Contact information
Practice address
1509 WILSON TER, 1420 S CENTRAL AVE, GLENDALE, CA 91206-4007
(818) 247-2095
(818) 247-1863
Mailing address
625 N MARYLAND AVE, GLENDALE, CA 91206-2245
(818) 247-2095
(818) 247-1863
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ75635Z
—
CA
Enumeration date
07/29/2006
Last updated
08/22/2020
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