Healthcare Provider Details

I. General information

NPI: 1144568114
Provider Name (Legal Business Name): DLS PACIFIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18433 HATTERAS ST # 306
TARZANA CA
91356-1955
US

IV. Provider business mailing address

18433 HATTERAS ST # 306
TARZANA CA
91356-1955
US

V. Phone/Fax

Practice location:
  • Phone: 310-279-6973
  • Fax:
Mailing address:
  • Phone: 310-279-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberARDMS # 104997
License Number StateMD

VIII. Authorized Official

Name: DENIS SOLDATENKO
Title or Position: CEO
Credential: RVT
Phone: 310-279-6973