Provider Demographics
NPI:1316127848
Name:SHICARE RADIOLOGY NETWORK
Entity type:Organization
Organization Name:SHICARE RADIOLOGY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAVAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-922-5111
Mailing Address - Street 1:5535 BALBOA BLVD.
Mailing Address - Street 2:SUITE 227
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1516
Mailing Address - Country:US
Mailing Address - Phone:877-922-5111
Mailing Address - Fax:310-715-8245
Practice Address - Street 1:5535 BALBOA BLVD.
Practice Address - Street 2:SUITE 227
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1516
Practice Address - Country:US
Practice Address - Phone:877-922-5111
Practice Address - Fax:310-715-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33257OtherSTATE LICENCE