Healthcare Provider Details

I. General information

NPI: 1235684457
Provider Name (Legal Business Name): EXPRESS RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E HERNDON AVE STE 108
FRESNO CA
93720-3100
US

IV. Provider business mailing address

2503 BEVERLY BLVD FL 1
LOS ANGELES CA
90057-1000
US

V. Phone/Fax

Practice location:
  • Phone: 559-656-0646
  • Fax: 559-412-8068
Mailing address:
  • Phone:
  • Fax: 213-353-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BORIS GRINSHTEYN
Title or Position: CEO
Credential:
Phone: 213-353-0552