Healthcare Provider Details

I. General information

NPI: 1891732723
Provider Name (Legal Business Name): FELIX BOGOMOLNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12729 VENTURA BLVD
STUDIO CITY CA
91604-2430
US

IV. Provider business mailing address

12729 VENTURA BLVD
STUDIO CITY CA
91604-2430
US

V. Phone/Fax

Practice location:
  • Phone: 818-508-1100
  • Fax: 818-508-1455
Mailing address:
  • Phone: 818-508-1100
  • Fax: 818-508-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number18010
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number103867
License Number StateCA

VIII. Authorized Official

Name: FELIX BOGOMOLNY
Title or Position: OWNER
Credential:
Phone: 818-508-1100