Organization
LOS ALAMITOS RADIOLOGY GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT POLEK (PRESIDENT)
(805) 375-8823
Entity
Organization
Contact information
Practice address
3751 KATELLA AVE, LOS ALAMITOS, CA 90720-3101
(562) 799-3294
Mailing address
PO BOX 650, NEWBURY PARK, CA 91319-0650
(800) 236-6608
(805) 375-8903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0103090
—
CA
01
—
ZZZ13653Z
BS
CA
Enumeration date
05/28/2006
Last updated
12/04/2019
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