Active NPI
Verdugo Radiology Medical Group, Inc.
- Diagnostic Radiology Physician
- Glendale, CA
National Provider Identifier
1710053012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- VERDUGO RADIOLOGY MEDICAL GROUP, INC.
- Practice address
- 1812 Verdugo Blvd
Glendale, CA 91208-1407 - Phone
- (818) 790-7100
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Craig E Moritz, M.D.
- Title
- President
- Phone
- (818) 248-9843
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | |||
| Neuroradiology Physician | 2085N0700X | |||
| Nuclear Radiology Physician | 2085N0904X | |||
| Pediatric Radiology Physician | 2085P0229X | |||
| Radiation Oncology Physician | 2085R0001X | |||
| Diagnostic Radiology Physician | 2085R0202X | Primary | ||
| Therapeutic Radiology Physician | 2085R0203X | |||
| Vascular & Interventional Radiology Physician | 2085R0204X | |||
| Radiological Physics Physician | 2085R0205X | |||
| Diagnostic Ultrasound Physician | 2085U0001X |
Addresses
Primary practice location
1812 Verdugo Blvd
Glendale, CA 91208-1407
Mailing address
P.O. Box 1036
Montrose, CA 91021-1036
Phone (818) 248-9843
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| YYY49281Y | Medicaid | CA |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1490140800000",
"number": "1710053012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1036",
"city": "MONTROSE",
"state": "CA",
"postal_code": "910211036",
"telephone_number": "818-248-9843",
"fax_number": "818-248-9884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1812 VERDUGO BLVD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912081407",
"telephone_number": "818-790-7100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VERDUGO RADIOLOGY MEDICAL GROUP, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-28",
"last_updated": "2017-03-22",
"status": "A",
"authorized_official_last_name": "MORITZ",
"authorized_official_first_name": "CRAIG",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "818-248-9843",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Body Imaging",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Neuroradiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Nuclear Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Pediatric Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Radiation Oncology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
},
{
"code": "2085R0203X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Therapeutic Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0204X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0205X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Radiological Physics",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Ultrasound",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "YYY49281Y",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.