Healthcare Provider Details

I. General information

NPI: 1619155967
Provider Name (Legal Business Name): OLEG GELLER ARDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11717 BALBOA BLVD
GRANADA HILLS CA
91344-2712
US

IV. Provider business mailing address

11717 BALBOA BLVD
GRANADA HILLS CA
91344-2712
US

V. Phone/Fax

Practice location:
  • Phone: 818-970-1972
  • Fax:
Mailing address:
  • Phone: 818-970-1972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: