Organization
RADIOLOGY DISC OF MIRACLE MILE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOZAFFAR REZVONPOUR (CEO)
(818) 986-3472
Entity
Organization
Contact information
Practice address
16661 VENTURA BLVD STE 100, ENCINO, CA 91436-1922
(818) 986-3472
(818) 986-2129
Mailing address
16661 VENTURA BLVD STE 100, ENCINO, CA 91436-1922
(818) 986-3472
(818) 986-2129
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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