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General NPI Number Information
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NPI Number | 1780630236
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Entity Type | Organization
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Legal Business Name | WILSHIRE IMAGING GROUP, INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6300 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-5204
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Country | US
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Telephone | 323-655-0363
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Fax | 323-655-0349
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Provider Business Mailing Address
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Address Line | 6300 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-5204
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Country | US
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Telephone | 323-655-0363
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Fax | 323-655-0349
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. SOFIA AGARONOVA
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Credential | OWNER
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Telephone | 323-359-1279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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