Healthcare Provider Details

I. General information

NPI: 1578264867
Provider Name (Legal Business Name): PREMIER DIAGNOSTIC & INTERVENTIONAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 SEPULVEDA BLVD STE 690
SHERMAN OAKS CA
91411-2522
US

IV. Provider business mailing address

5805 SEPULVEDA BLVD STE 690
SHERMAN OAKS CA
91411-2522
US

V. Phone/Fax

Practice location:
  • Phone: 818-900-6480
  • Fax:
Mailing address:
  • Phone: 818-900-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NAVID EGHBALIEH
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 310-650-4500