Organization
CENTURY RADIOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN FIELDS M.D. (MEDICAL DIRECTOR)
(562) 602-6810
Entity
Organization
Contact information
Practice address
3700 SOUTH ST, LAKEWOOD, CA 90712-1419
(562) 602-6810
(562) 630-3594
Mailing address
PO BOX 190, SIMI VALLEY, CA 93062-0190
(805) 522-5940
(805) 522-6401
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE7194
RAILROAD MEDICARE
—
05
—
GR0013840
—
CA
05
—
GR0013841
—
CA
01
—
ZZZ13785Z
BLUE SHIELD
—
01
—
ZZZ13968Z
BLUE SHIELD
—
01
—
ZZZ15759Z
BLUE SHIELD
—
01
—
ZZZ76869Z
BLUE SHIELD
—
05
—
ZZZ76869Z
—
CA
Enumeration date
05/20/2006
Last updated
02/22/2018
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