Healthcare Provider Details

I. General information

NPI: 1265731210
Provider Name (Legal Business Name): VERA KLESIC TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 W PICO BLVD 500
LOS ANGELES CA
90035-2703
US

IV. Provider business mailing address

9911 W PICO BLVD 500
LOS ANGELES CA
90035-2703
US

V. Phone/Fax

Practice location:
  • Phone: 310-203-8899
  • Fax: 310-203-8555
Mailing address:
  • Phone: 310-203-8899
  • Fax: 310-203-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: