Provider Demographics
NPI:1538449525
Name:COMPREHENSIVE RADIOLOGY ANALYSIS
Entity type:Organization
Organization Name:COMPREHENSIVE RADIOLOGY ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUKASZEK-SECOUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-922-2986
Mailing Address - Street 1:5024 KATELLA AVE STE 132
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2802
Mailing Address - Country:US
Mailing Address - Phone:888-922-2986
Mailing Address - Fax:800-503-6603
Practice Address - Street 1:5024 KATELLA AVE STE 132
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2802
Practice Address - Country:US
Practice Address - Phone:888-922-2986
Practice Address - Fax:800-503-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 0385652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty