Healthcare Provider Details

I. General information

NPI: 1992751341
Provider Name (Legal Business Name): INLAND NEURODIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 LAUREL CANYON BLVD SUITE 370
NORTH HOLLYWOOD CA
91606-3200
US

IV. Provider business mailing address

6350 LAUREL CANYON BLVD SUITE 370
NORTH HOLLYWOOD CA
91606-3200
US

V. Phone/Fax

Practice location:
  • Phone: 818-623-4404
  • Fax: 818-623-4450
Mailing address:
  • Phone: 818-623-4404
  • Fax: 818-623-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. NUNU DARAKHVELIDZE
Title or Position: PRINCIPAL
Credential:
Phone: 818-430-6273