Provider Demographics
NPI:1487177200
Name:ONTARIO INTERVENTIONAL CENTER
Entity type:Organization
Organization Name:ONTARIO INTERVENTIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANISER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-235-7490
Mailing Address - Street 1:1520 N MOUNTAIN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1133
Mailing Address - Country:US
Mailing Address - Phone:909-235-7490
Mailing Address - Fax:909-391-9101
Practice Address - Street 1:1520 N MOUNTAIN AVE STE 205
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1133
Practice Address - Country:US
Practice Address - Phone:909-235-7490
Practice Address - Fax:909-391-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty