Organization
I V RADIOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R HADORN MD (PARTNER OF IMPERIAL VALLEY RADIOLOG)
(760) 339-7241
Entity
Organization
Contact information
Practice address
1415 ROSS AVE, EL CENTRO, CA 92243-4306
(760) 339-7241
(760) 339-7249
Mailing address
PO BOX 889, WOODLAND HILLS, CA 91365-0889
(805) 375-8800
(805) 375-8900
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0015902
—
CA
01
—
ZZT30045F
MCAL IP FACILITY ID#
CA
01
—
ZZT40045F
MCAL OP FACILITY ID #
CA
Enumeration date
01/02/2007
Last updated
03/24/2021
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