MEDICARE: PROFESSIONAL IMAGING NETWORK

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	:	1417054701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL IMAGING NETWORK

Provider Business Mailing Address
First Line	:	6363 WILSHIRE BLVD
Second Line	:	# 310
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5701
Country	:	US
Telephone Number	:	323-653-6111
Fax Number	:	323-653-6220

Provider Business Practice Location Address
First Line	:	6363 WILSHIRE BLVD
Second Line	:	# 310
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5701
Country	:	US
Telephone Number	:	323-653-6111
Fax Number	:	323-653-6220

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANNA I LABUTINA
Credential	:
Telephone Number	:	323-653-6111

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/21/2022

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Directions to “PROFESSIONAL IMAGING NETWORK ” Practice Location

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