Provider Demographics
NPI:1760475040
Name:HOLLYWOOD DIAGNOSTIC SERVICE
Entity Type:Organization
Organization Name:HOLLYWOOD DIAGNOSTIC SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:LIFSHITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-463-7030
Mailing Address - Street 1:PO BOX 17255
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-7255
Mailing Address - Country:US
Mailing Address - Phone:323-463-7030
Mailing Address - Fax:323-463-0106
Practice Address - Street 1:7080 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 820
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6906
Practice Address - Country:US
Practice Address - Phone:323-463-7030
Practice Address - Fax:323-463-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19698ZMedicare ID - Type UnspecifiedNHIC NORTH
CATG091Medicare ID - Type UnspecifiedNHIC SOUTH