Organization
BROADWAY IMAGING MEDICAL CENTER
Active
Other names
Broadway Imaging Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
HOSAM M MOUSTAFA MD (PRESIDENT)
(818) 548-0022
Entity
Organization
Contact information
Practice address
140 NORTH GLENDALE AVE, GLENDALE, CA 91206
(818) 548-0022
(818) 548-8385
Mailing address
140 NORTH GLENDALE AVE, GLENDALE, CA 91206
(818) 548-0022
(818) 548-8385
Taxonomy
Speciality
Code
Description
License number
State
207RM1200X
Magnetic Resonance Imaging (MRI) Internal Medicine Physician
A71010
CA
2085R0202X
Diagnostic Radiology Physician
Primary
A71010
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A710100
—
CA
Enumeration date
05/18/2006
Last updated
08/12/2018
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