MEDICARE: HOLLYWOOD IMAGING&DIAGNOSTIC.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	2085U0001X	Diagnostic Ultrasound Physician

General Provider Information

NPI Number	:	1386697563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD IMAGING&DIAGNOSTIC.INC

Provider Business Mailing Address
First Line	:	6404 WILSHIRE BLVD
Second Line	:	SUITE#705
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5509
Country	:	US
Telephone Number	:	323-782-9383
Fax Number	:	323-782-9560

Provider Business Practice Location Address
First Line	:	6404 WILSHIRE BLVD
Second Line	:	SUITE#705
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5501
Country	:	US
Telephone Number	:	323-782-9383
Fax Number	:	323-782-9560

Authorized Official
Title or Position	:	CEO
Name	:	MARINA GEYKMAN
Credential	:
Telephone Number	:	323-782-9383

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/26/2013

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