Provider Demographics
NPI:1215189287
Name:ELITE DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:ELITE DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:TSYMBALOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-719-0080
Mailing Address - Street 1:6164 TONY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1249
Mailing Address - Country:US
Mailing Address - Phone:818-719-0080
Mailing Address - Fax:818-719-0088
Practice Address - Street 1:6164 TONY AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1249
Practice Address - Country:US
Practice Address - Phone:818-719-0080
Practice Address - Fax:818-719-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile