Organization
SOUTH VALLEY RADIOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD MARK GRITZ MD (PRESIDENT)
(818) 726-6480
Entity
Organization
Contact information
Practice address
18344 CLARK ST, SUITE 101, TARZANA, CA 91356-3505
(818) 881-9811
(818) 881-1638
Mailing address
FILE 1261, 1801 W. OLYMPIC BOULEVARD, PASADENA, CA 91199-0665
(877) 406-2916
(800) 656-0592
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0092560
—
CA
05
—
GR0092562
—
CA
01
—
ZZZ65198Z
BLUE SHIELD
CA
01
—
ZZZ65200Z
BLUE SHIELD
CA
01
—
ZZZ65201Z
BLUE SHIELD
CA
01
—
ZZZ65202Z
BLUE SHIELD
CA
01
—
ZZZ65212Z
BLUE SHIELD
CA
01
—
ZZZ65301Z
BLUE SHIELD
CA
05
—
ZZZ80581Z
—
CA
Enumeration date
05/27/2006
Last updated
12/01/2015
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