Provider Demographics
NPI:1083898167
Name:URUSHADZE, TEIMURAZ (RDCS,RVT,ARDMS(ABD)
Entity Type:Individual
Prefix:
First Name:TEIMURAZ
Middle Name:
Last Name:URUSHADZE
Suffix:
Gender:M
Credentials:RDCS,RVT,ARDMS(ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 WILSHIRE BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5105
Mailing Address - Country:US
Mailing Address - Phone:310-770-9528
Mailing Address - Fax:
Practice Address - Street 1:6210 WILSHIRE BLVD
Practice Address - Street 2:STE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5105
Practice Address - Country:US
Practice Address - Phone:310-770-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106048246XS1301X, 2471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography