Healthcare Provider Details

I. General information

NPI: 1942566484
Provider Name (Legal Business Name): PREMIER DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20929 VENTURA BLVD 47-350
WOODLAND HILLS CA
91364-2334
US

IV. Provider business mailing address

20929 VENTURA BLVD 47-350
WOODLAND HILLS CA
91364-2334
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-0152
  • Fax: 818-505-0398
Mailing address:
  • Phone: 818-505-0152
  • Fax: 818-505-0398

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 Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YANIV FARBENBLOOMM
Title or Position: PRESIDENT
Credential: DC
Phone: 818-505-0152