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General NPI Number Information
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NPI Number | 1003342262
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Entity Type | Organization
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Legal Business Name | MINT SERVICES
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 12183 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606
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Country | US
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Telephone | 818-623-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 11333 MOORPARK ST # 402
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City | STUDIO CITY
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State | CA
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Zip | 91602-2618
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Country | US
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Telephone | 818-623-8100
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | GENNADY SATANOVSKY
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Credential |
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Telephone | 213-260-4891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0202X
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Taxonomy Name | Clinical Biochemical Genetics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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