MEDICARE: MID-VALLEY IMAGING, LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1396087060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-VALLEY IMAGING, LLC

Provider Business Mailing Address
First Line	:	14622 VENTURA BLVD.
Second Line	:	#725
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3600
Country	:	US
Telephone Number	:	818-306-5597
Fax Number	:	866-415-9481

Provider Business Practice Location Address
First Line	:	6303 OWENSMOUTH AVENUE, FL 10
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	91367-2263
Country	:	US
Telephone Number	:	818-306-5597
Fax Number	:	800-900-4118

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATT SABRKHANI
Credential	:
Telephone Number	:	818-294-7266

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	05/15/2015

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Directions to “MID-VALLEY IMAGING, LLC ” Practice Location

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