Healthcare Provider Details

I. General information

NPI: 1174341242
Provider Name (Legal Business Name): RM HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12918 SHERMAN WAY UNIT 222
N HOLLYWOOD CA
91605-4953
US

IV. Provider business mailing address

12918 SHERMAN WAY UNIT 222
N HOLLYWOOD CA
91605-4953
US

V. Phone/Fax

Practice location:
  • Phone: 702-521-2449
  • Fax:
Mailing address:
  • Phone: 702-521-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROMAN MARDANOV
Title or Position: OWNER
Credential:
Phone: 702-521-2449