MEDICARE: US DIAGNOSTIC LV MANAGEMENT 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	2085U0001X	Diagnostic Ultrasound Physician

General Provider Information

NPI Number	:	1962091926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US DIAGNOSTIC LV MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	1600 E DESERT INN RD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2505
Country	:	US
Telephone Number	:	747-477-1064
Fax Number	:	747-477-1182

Provider Business Practice Location Address
First Line	:	1621 E FLAMINGO RD STE 15B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5276
Country	:	US
Telephone Number	:	725-735-4042
Fax Number	:	747-477-1182

Authorized Official
Title or Position	:	CEO
Name	:	MARINA AGASYAN
Credential	:
Telephone Number	:	725-735-4042

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	02/04/2025

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