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General NPI Number Information
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NPI Number | 1295884831
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Entity Type | Organization
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Legal Business Name | QUALITY IMAGING DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 8383 WILSHIRE BLVD SUITE #348
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2412
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Country | US
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Telephone | 323-658-5830
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Fax | 323-655-1619
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Provider Business Mailing Address
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Address Line | 8383 WILSHIRE BLVD SUITE #348
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2412
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Country | US
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Telephone | 323-658-5830
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Fax | 323-655-1619
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARINA KOKUASHVILI
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Credential |
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Telephone | 323-658-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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