Provider Demographics
NPI:1780633438
Name:RADCO MANAGEMENT, LLC
Entity type:Organization
Organization Name:RADCO MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REYNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-944-0881
Mailing Address - Street 1:PO BOX 2966
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-2966
Mailing Address - Country:US
Mailing Address - Phone:562-944-0881
Mailing Address - Fax:562-944-0801
Practice Address - Street 1:15651 IMPERIAL HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1628
Practice Address - Country:US
Practice Address - Phone:562-944-0881
Practice Address - Fax:562-944-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD071Medicare ID - Type Unspecified