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General NPI Number Information
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NPI Number | 1295712339
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Entity Type | Organization
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Legal Business Name | US TECH DIAGNOSTIC INC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14426 GILMORE ST
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City | VAN NUYS
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State | CA
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Zip | 91401-1429
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Country | US
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Telephone | 818-908-0551
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Fax | 818-908-0532
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Provider Business Mailing Address
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Address Line | 17071 VENTURA BLVD #225
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City | ENCINO
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State | CA
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Zip | 91316-4130
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Country | US
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Telephone | 818-789-4170
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Fax | 818-789-4177
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLGA KALASHNIKOV
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Credential |
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Telephone | 818-789-4170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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