Provider Demographics
NPI:1588714745
Name:QUALITY IMAGING DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:QUALITY IMAGING DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKUASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-658-5830
Mailing Address - Street 1:8383 WILSHIRE BLVD.
Mailing Address - Street 2:STE # 348
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2415
Mailing Address - Country:US
Mailing Address - Phone:323-658-5830
Mailing Address - Fax:323-655-1619
Practice Address - Street 1:8383 WILSHIRE BLVD
Practice Address - Street 2:STE # 348
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2412
Practice Address - Country:US
Practice Address - Phone:323-658-5830
Practice Address - Fax:323-655-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG065Medicare ID - Type UnspecifiedSOUTHERN