Provider Demographics
NPI:1972080356
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:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-375-8804
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:805-375-8804
Mailing Address - Fax:770-237-1429
Practice Address - Street 1:3406 KILDARE CT
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1665
Practice Address - Country:US
Practice Address - Phone:805-375-8804
Practice Address - Fax:770-237-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty