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General NPI Number Information
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NPI Number | 1780808097
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Entity Type | Organization
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Legal Business Name | VAL P SHULMAN
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 7559 SANTA MONICA BLVD # 200
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City | LOS ANGELES
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State | CA
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Zip | 90046-6406
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Country | US
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Telephone | 323-878-2570
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Fax | 323-878-2574
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Provider Business Mailing Address
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Address Line | 7559 SANTA MONICA BLVD # 200
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City | LOS ANGELES
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State | CA
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Zip | 90046-6406
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Country | US
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Telephone | 323-878-2570
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Fax | 323-878-2574
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Authorized Official
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Title or Position | OWNER
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Name | VALERY P SHULMAN
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Credential | MD
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Telephone | 323-878-2570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | A38820
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License Number State | CA
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