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Organization

SO CAL IMAGING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARK KAPPICO (MEMBER)
(805) 241-0742
Entity
Organization

Contact information

Practice address
2075 HATHAWAY AVE, WESTLAKE VILLAGE, CA 91362-5171
(818) 312-4555
Mailing address
3835 RE THOUSAND OAKS BLVD., #385, WESTLAKE VILLAGE, CA 91362
(818) 312-4555
(800) 915-0607

Taxonomy

Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
305S00000X
Point of Service
Primary

Other

Enumeration date
11/29/2018
Last updated
11/29/2018
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