MEDICARE: TEIMURAZ URUSHADZE RDCS.,RVT.,ARDMS(ABD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246XS1301X	Sonography Specialist/Technologist Cardiovascular	106048	MD
2	2471S1302X	Sonography Radiologic Technologist	106048	MD
3	2471V0105X	Vascular Sonography Radiologic Technologist	106048	MD

General Provider Information

NPI Number	:	1083898167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEIMURAZ URUSHADZE RDCS.,RVT.,ARDMS(ABD

Provider Business Mailing Address
First Line	:	6210 WILSHIRE BLVD
Second Line	:	STE 205
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5105
Country	:	US
Telephone Number	:	310-770-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	6210 WILSHIRE BLVD
Second Line	:	STE 205
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5105
Country	:	US
Telephone Number	:	310-770-9528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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