=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710905617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUCLEAR DIAGNOSTIC IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5995 TOPANGA CANYON BLVD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-888-7009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5995 TOPANGA CANYON BLVD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-888-7009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ANNA ZARRIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-888-7009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 7277-19
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------