Provider Demographics
NPI:1417054701
Name:PROFESSIONAL IMAGING NETWORK
Entity Type:Organization
Organization Name:PROFESSIONAL IMAGING NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:I
Authorized Official - Last Name:LABUTINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-653-6111
Mailing Address - Street 1:6363 WILSHIRE BLVD
Mailing Address - Street 2:# 310
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5701
Mailing Address - Country:US
Mailing Address - Phone:323-653-6111
Mailing Address - Fax:323-653-6220
Practice Address - Street 1:6363 WILSHIRE BLVD
Practice Address - Street 2:# 310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5701
Practice Address - Country:US
Practice Address - Phone:323-653-6111
Practice Address - Fax:323-653-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG 104Medicare ID - Type Unspecified