Organization
J. BRUCE JACOBS, MD, INC
Active
Other names
VALLEY RADIOLOGY OF ENCINO
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER USMANOV M.D. (PRESIDENT)
(818) 776-9100
Entity
Organization
Contact information
Practice address
17779 VENTURA BLVD, ENCINO, CA 91316-3717
(818) 776-9100
(818) 776-0544
Mailing address
17779 VENTURA BLVD, ENCINO, CA 91316-3717
(818) 776-9100
(818) 776-0544
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A21604
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588967566
—
CA
Enumeration date
12/13/2010
Last updated
01/28/2014
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