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General NPI Number Information
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NPI Number | 1013081058
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Entity Type | Organization
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Legal Business Name | BOBODZHANOV INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 440 W BRODERICK DR
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City | MERIDIAN
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State | ID
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Zip | 83646-6427
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Country | US
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Telephone | 206-786-6936
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Fax | 206-621-4176
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Provider Business Mailing Address
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Address Line | 440 W BRODERICK DR
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City | MERIDIAN
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State | ID
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Zip | 83646-6427
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Country | US
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Telephone | 206-786-6936
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Fax | 206-621-4176
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. ALEXI BOBODZHANOV
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Credential | RDMS, RDCS
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Telephone | 206-621-4722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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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 | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | N/A PORTABLE U/S
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 246XS1301X
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Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
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License Number |
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License Number State |
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