Provider Demographics
NPI:1053464156
Name:VITAL SCAN INC
Entity Type:Organization
Organization Name:VITAL SCAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-653-2200
Mailing Address - Street 1:PO BOX 48708
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-0708
Mailing Address - Country:US
Mailing Address - Phone:323-653-2200
Mailing Address - Fax:323-651-1970
Practice Address - Street 1:6399 WILSHIRE BLVD
Practice Address - Street 2:SUITE 319-321
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5703
Practice Address - Country:US
Practice Address - Phone:323-653-2200
Practice Address - Fax:323-651-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG 370Medicare ID - Type UnspecifiedIDTF