Organization
MEDICAL GROUP IMAGING CENTER OF GLENDALE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEVERIANO VALENZUELA M.D. (RADIOLOGIST MEDICAL DIRECTOR OWNER)
(818) 241-5072
Entity
Organization
Contact information
Practice address
1030 S GLENDALE AVE, #200, GLENDALE, CA 91205-5612
(818) 241-5072
Mailing address
1056 TYLER LN, UPLAND, CA 91784-9279
(909) 982-2985
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G206170
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0021240
—
CA
Enumeration date
11/01/2006
Last updated
08/22/2020
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