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General NPI Number Information
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NPI Number | 1639352453
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Entity Type | Organization
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Legal Business Name | CAPSULE ENDOSCOPY SERVICES INC.
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 9499 W CHARLESTON BLVD SUITE 150
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City | LAS VEGAS
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State | NV
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Zip | 89117-7147
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Country | US
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Telephone | 702-478-7941
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Fax | 702-478-7951
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Provider Business Mailing Address
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Address Line | 100 UCLA MEDICAL PLAZA SUITE 310
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-825-5381
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Fax | 310-825-5390
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROME JUTABHA
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Credential | M.D.
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Telephone | 702-478-7941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 11774
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License Number State | NV
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