Provider Demographics
NPI:1427005024
Name:LOS ALAMITOS RADIOLOGY GROUP INC
Entity type:Organization
Organization Name:LOS ALAMITOS RADIOLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-375-8823
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-0650
Mailing Address - Country:US
Mailing Address - Phone:800-236-6608
Mailing Address - Fax:805-375-8903
Practice Address - Street 1:3751 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3101
Practice Address - Country:US
Practice Address - Phone:562-799-3294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13653ZOtherBS
CAGR0103090Medicaid
CADE8476Medicare PIN
CAGR0103090Medicaid