Healthcare Provider Details

I. General information

NPI: 1982900809
Provider Name (Legal Business Name): OAKHURST DIAGNOSTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 WILSHIRE BLVD 250
BEVERLY HILLS CA
90212
US

IV. Provider business mailing address

9150 WILSHIRE BLVD 250
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-9969
  • Fax: 310-271-9575
Mailing address:
  • Phone: 310-271-9969
  • Fax: 310-271-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number20457
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID TANNENBAUM
Title or Position: CEO
Credential:
Phone: 310-271-9969