Healthcare Provider Details

I. General information

NPI: 1013081058
Provider Name (Legal Business Name): BOBODZHANOV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W BRODERICK DR
MERIDIAN ID
83646-6427
US

IV. Provider business mailing address

440 W BRODERICK DR
MERIDIAN ID
83646-6427
US

V. Phone/Fax

Practice location:
  • Phone: 206-786-6936
  • Fax: 206-621-4176
Mailing address:
  • Phone: 206-786-6936
  • Fax: 206-621-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberN/A PORTABLE U/S
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXI BOBODZHANOV
Title or Position: PRESIDENT CEO
Credential: RDMS, RDCS
Phone: 206-621-4722