MEDICARE: NEW MILLENIUM MOBILE DIAGNOSTIC SERVICES

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	293D00000X	Physiological Laboratory		CA

General Provider Information

NPI Number	:	1568407203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MILLENIUM MOBILE DIAGNOSTIC SERVICES

Provider Business Mailing Address
First Line	:	2500 WILSHIRE BLVD
Second Line	:	SUITE # 1122
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4303
Country	:	US
Telephone Number	:	213-387-5005
Fax Number	:	213-387-5006

Provider Business Practice Location Address
First Line	:	2500 WILSHIRE BLVD
Second Line	:	SUITE # 1122
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4303
Country	:	US
Telephone Number	:	213-387-5005
Fax Number	:	213-387-5006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEKSANDR BROMBERG
Credential	:
Telephone Number	:	213-387-5005

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2020

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