Healthcare Provider Details

I. General information

NPI: 1386697563
Provider Name (Legal Business Name): HOLLYWOOD IMAGING&DIAGNOSTIC.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 WILSHIRE BLVD SUITE#705
LOS ANGELES CA
90048-5501
US

IV. Provider business mailing address

6404 WILSHIRE BLVD SUITE#705
LOS ANGELES CA
90048-5509
US

V. Phone/Fax

Practice location:
  • Phone: 323-782-9383
  • Fax: 323-782-9560
Mailing address:
  • Phone: 323-782-9383
  • Fax: 323-782-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MARINA GEYKMAN
Title or Position: CEO
Credential:
Phone: 323-782-9383