Organization
GLENDORA RADIOLOGICAL ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID JOSEPH UNDERWOOD MD (PRESIDENT)
(626) 339-5464
Entity
Organization
Contact information
Practice address
210 W SAN BERNARDINO RD, COVINA, CA 91723-1515
(626) 339-5464
Mailing address
414 E SAN BERNARDINO RD, COVINA, CA 91723-1704
(626) 339-5464
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
A129256
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB240265
MEDICARE PTAN
CA
01
—
CB240266
MEDICARE PTAN
—
Enumeration date
12/07/2016
Last updated
12/07/2016
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