Provider Demographics
NPI:1386697563
Name:HOLLYWOOD IMAGING&DIAGNOSTIC.INC
Entity type:Organization
Organization Name:HOLLYWOOD IMAGING&DIAGNOSTIC.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEYKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-782-9383
Mailing Address - Street 1:6404 WILSHIRE BLVD
Mailing Address - Street 2:SUITE#705
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5509
Mailing Address - Country:US
Mailing Address - Phone:323-782-9383
Mailing Address - Fax:323-782-9560
Practice Address - Street 1:6404 WILSHIRE BLVD
Practice Address - Street 2:SUITE#705
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5501
Practice Address - Country:US
Practice Address - Phone:323-782-9383
Practice Address - Fax:323-782-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG-090Medicare ID - Type Unspecified
CATG 090Medicare PIN