Healthcare Provider Details

I. General information

NPI: 1487607925
Provider Name (Legal Business Name): PRIVILEGE IMAGING,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N VIRGIL AVE
LOS ANGELES CA
90004-5399
US

IV. Provider business mailing address

240 N VIRGIL AVE
LOS ANGELES CA
90004-5293
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-9533
  • Fax:
Mailing address:
  • Phone: 310-277-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: KARINE AIVAZOVA
Title or Position: CEO
Credential:
Phone: 310-277-9533