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General NPI Number Information
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NPI Number | 1356887889
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Entity Type | Organization
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Legal Business Name | PROCREATE 4D LLC
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Dates
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Enumeration Date | 01/08/2017
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 5161 POMONA BLVD STE 213
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City | LOS ANGELES
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State | CA
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Zip | 90022-1749
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Country | US
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Telephone | 626-316-0829
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Fax |
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Provider Business Mailing Address
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Address Line | 5161 POMONA BLVD STE 213
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City | LOS ANGELES
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State | CA
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Zip | 90022-1749
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Country | US
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Telephone | 626-316-0829
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSE FERNANDO FARIAS
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Credential |
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Telephone | 626-316-0829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 0002946802-0001-1
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License Number State | CA
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