Healthcare Provider Details

I. General information

NPI: 1255181947
Provider Name (Legal Business Name): SEA IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S GLENWOOD PL # 204
BURBANK CA
91506-2819
US

IV. Provider business mailing address

639 S GLENWOOD PL # 204
BURBANK CA
91506-2819
US

V. Phone/Fax

Practice location:
  • Phone: 818-414-1516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MINAS ELMASIAN
Title or Position: OWNER
Credential: RT
Phone: 818-414-1516