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General NPI Number Information
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NPI Number | 1568407203
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Entity Type | Organization
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Legal Business Name | NEW MILLENIUM MOBILE DIAGNOSTIC SERVICES
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2500 WILSHIRE BLVD SUITE # 1122
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City | LOS ANGELES
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State | CA
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Zip | 90057-4303
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Country | US
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Telephone | 213-387-5005
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Fax | 213-387-5006
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Provider Business Mailing Address
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Address Line | 2500 WILSHIRE BLVD SUITE # 1122
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City | LOS ANGELES
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State | CA
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Zip | 90057-4303
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Country | US
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Telephone | 213-387-5005
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Fax | 213-387-5006
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALEKSANDR BROMBERG
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Credential |
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Telephone | 213-387-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State | CA
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