Healthcare Provider Details

I. General information

NPI: 1477198125
Provider Name (Legal Business Name): GREGORY BARSOM RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 LOS FELIZ BLVD
LOS ANGELES CA
90027-1918
US

IV. Provider business mailing address

4740 LOS FELIZ BLVD
LOS ANGELES CA
90027-1918
US

V. Phone/Fax

Practice location:
  • Phone: 323-806-6670
  • Fax:
Mailing address:
  • Phone: 323-806-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number147770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: