Provider Demographics
NPI:1477198125
Name:BARSOM, GREGORY (RVT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BARSOM
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 LOS FELIZ BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1918
Mailing Address - Country:US
Mailing Address - Phone:323-806-6670
Mailing Address - Fax:
Practice Address - Street 1:4740 LOS FELIZ BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1918
Practice Address - Country:US
Practice Address - Phone:323-806-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147770246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography