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General NPI Number Information
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NPI Number | 1356396170
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Entity Type | Organization
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Legal Business Name | MEDLINE DIAGNOSTIC CENTER, INC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1720 COLORADO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-1338
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Country | US
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Telephone | 323-254-8600
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Fax | 323-254-8700
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Provider Business Mailing Address
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Address Line | 1720 COLORADO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-1338
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Country | US
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Telephone | 323-254-8600
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Fax | 323-254-8700
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GALINA PANASSENKO
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Credential |
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Telephone | 818-254-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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