MEDICARE: ADVANCED DIAGNOSTIC SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center	261QR0208X	CA

General Provider Information

NPI Number	:	1104877323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DIAGNOSTIC SERVICES INC.

Provider Business Mailing Address
First Line	:	3540 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2307
Country	:	US
Telephone Number	:	323-665-4072
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARZIK SHATVEROV
Credential	:
Telephone Number	:	323-665-4072

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/22/2020

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