Provider Demographics
NPI:1285846345
Name:PRIVILEGE IMAGING INC
Entity Type:Organization
Organization Name:PRIVILEGE IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYVAZOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1310-774-7747
Mailing Address - Street 1:240 N VIRGIL AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3650
Mailing Address - Country:US
Mailing Address - Phone:131-077-4774
Mailing Address - Fax:
Practice Address - Street 1:240 N VIRGIL AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3650
Practice Address - Country:US
Practice Address - Phone:131-077-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP00003456247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG363Medicare ID - Type UnspecifiedIDTF