Organization
GLENDORA RADIOLOGICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J. UNDERWOOD MD (PRESIDENT)
(626) 339-5464
Entity
Organization
Contact information
Practice address
414 E SAN BERNARDINO RD, COVINA, CA 91723-1704
(626) 339-5464
(626) 331-2313
Mailing address
414 E SAN BERNARDINO RD, COVINA, CA 91723-1704
(800) 475-3698
(626) 331-2313
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP3326
RAIL ROAD MEDICARE GRP #
CA
05
—
GR0011500
—
CA
05
—
GR0011502
—
CA
01
—
ZZZ14525Z
BLUE SHIELD PROVIDER
CA
01
—
ZZZ35484Z
BLUE SHIELD PROVIDER
CA
Enumeration date
08/16/2005
Last updated
10/04/2019
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