Provider Demographics
NPI:1144568114
Name:DLS PACIFIC
Entity Type:Organization
Organization Name:DLS PACIFIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLDATENKO
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:310-279-6973
Mailing Address - Street 1:18433 HATTERAS ST
Mailing Address - Street 2:# 306
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1955
Mailing Address - Country:US
Mailing Address - Phone:310-279-6973
Mailing Address - Fax:
Practice Address - Street 1:18433 HATTERAS ST
Practice Address - Street 2:# 306
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1955
Practice Address - Country:US
Practice Address - Phone:310-279-6973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDARDMS # 104997261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile