=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336212505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME ULTRASOUND SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 07/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16200 VENTURA BLVD #402
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-7877
-----------------------------------------------------
Fax | 818-788-7833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16200 VENTURA BLVD #402
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-7877
-----------------------------------------------------
Fax | 818-788-7833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ALEX MARGULYAN
-----------------------------------------------------
Credential | ARDMS
-----------------------------------------------------
Telephone | 818-788-7877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------