MEDICARE: HOLLYWOOD DIAGNOSTIC SERVICE

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

General Provider Information

NPI Number	:	1760475040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD DIAGNOSTIC SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 17255
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91416-7255
Country	:	US
Telephone Number	:	323-463-7030
Fax Number	:	323-463-0106

Provider Business Practice Location Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:	SUITE 820
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6906
Country	:	US
Telephone Number	:	323-463-7030
Fax Number	:	323-463-0106

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VLADIMIR LIFSHITS
Credential	:
Telephone Number	:	323-463-7030

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	06/27/2017

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Directions to “HOLLYWOOD DIAGNOSTIC SERVICE ” Practice Location

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