Healthcare Provider Details

I. General information

NPI: 1811431182
Provider Name (Legal Business Name): CARDIAC IMAGING NUCLEAR ASSOCIATES, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 W OLYMPIC BLVD STE 1150
LOS ANGELES CA
90064-5078
US

IV. Provider business mailing address

11835 W OLYMPIC BLVD STE 1150
LOS ANGELES CA
90064-5078
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-7610
  • Fax: 888-808-0270
Mailing address:
  • Phone: 323-655-7610
  • Fax: 888-808-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberG79325
License Number StateCA

VIII. Authorized Official

Name: HOWARD C LEWIN
Title or Position: PRESIDENT
Credential: MD
Phone: 323-655-7610