Provider Demographics
NPI:1992751341
Name:INLAND NEURODIAGNOSTICS INC
Entity type:Organization
Organization Name:INLAND NEURODIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:NUNU
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAKHVELIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-430-6273
Mailing Address - Street 1:6350 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3200
Mailing Address - Country:US
Mailing Address - Phone:818-623-4404
Mailing Address - Fax:818-623-4450
Practice Address - Street 1:6350 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3200
Practice Address - Country:US
Practice Address - Phone:818-623-4404
Practice Address - Fax:818-623-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
Not Answered261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Single Specialty