Provider Demographics
NPI:1306084850
Name:FRONTIER MEDICAL IMAGING INC.
Entity type:Organization
Organization Name:FRONTIER MEDICAL IMAGING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GELFANDBEYN
Authorized Official - Suffix:
Authorized Official - Credentials:SONOGRAPHER
Authorized Official - Phone:323-459-2983
Mailing Address - Street 1:14332 DICKENS ST
Mailing Address - Street 2:#08
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423
Mailing Address - Country:US
Mailing Address - Phone:323-459-2983
Mailing Address - Fax:818-905-7274
Practice Address - Street 1:14332 DICKENS ST
Practice Address - Street 2:#08
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423
Practice Address - Country:US
Practice Address - Phone:323-459-2983
Practice Address - Fax:818-905-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA.R.D.M.S.1062042471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty