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General NPI Number Information
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NPI Number | 1114165875
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Entity Type | Organization
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Legal Business Name | NEW IMAGE CREATIONS, INC.
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 14624 SHERMAN WAY SUITE 409
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City | VAN NUYS
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State | CA
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Zip | 91405-2241
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Country | US
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Telephone | 818-782-8300
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Fax | 818-782-8301
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Provider Business Mailing Address
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Address Line | 4335 VAN NUYS BLVD SUITE 315
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3727
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Country | US
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Telephone | 818-782-8300
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Fax | 818-782-8301
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Authorized Official
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Title or Position | CEO
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Name | DAVID OPAI-TETTEH
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Credential | M.D.
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Telephone | 818-782-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A53194
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License Number State | CA
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