Provider Demographics
NPI:1346287745
Name:STIM DIAGNOSTIC, INC.
Entity Type:Organization
Organization Name:STIM DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASILSHCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-774-1512
Mailing Address - Street 1:18401 BURBANK BLVD
Mailing Address - Street 2:SUITE # 123
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2822
Mailing Address - Country:US
Mailing Address - Phone:818-774-1512
Mailing Address - Fax:818-774-1311
Practice Address - Street 1:18401 BURBANK BLVD
Practice Address - Street 2:SUITE # 123
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2822
Practice Address - Country:US
Practice Address - Phone:818-774-1512
Practice Address - Fax:818-774-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG376Medicare ID - Type UnspecifiedIDTF