Provider Demographics
NPI:1104073659
Name:ENCINO OPEN MRI INC
Entity type:Organization
Organization Name:ENCINO OPEN MRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKHTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLBAHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-986-4786
Mailing Address - Street 1:17323 VENTURA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17323 VENTURA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3964
Practice Address - Country:US
Practice Address - Phone:818-986-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)