Organization
SOCAL MR SITE MANAGEMENT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD G. BERGER MD (PRESIDENT)
(310) 445-2800
Entity
Organization
Contact information
Practice address
740 E ARROW HWY, SUITE A, COVINA, CA 91722-2144
(626) 966-1580
(626) 967-7821
Mailing address
1037 N GRAND AVE PMB 203, COVINA, CA 91724-2048
(310) 445-2800
(310) 445-2816
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059840
—
CA
05
—
GR0090660
—
CA
05
—
GR0090661
—
CA
01
—
ZZZ19215Z
BLUE SHIELD
CA
01
—
ZZZ23491Z
BLUE SHIELD
CA
01
—
ZZZ45829Z
BLUE SHIELD
CA
Enumeration date
07/03/2006
Last updated
08/22/2020
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