Provider Demographics
NPI:1851311757
Name:I.S.B. DIAGNOSTIC SERVICES,INC.
Entity Type:Organization
Organization Name:I.S.B. DIAGNOSTIC SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-782-2688
Mailing Address - Street 1:14557 FRIAR ST STUITE #140
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411
Mailing Address - Country:US
Mailing Address - Phone:818-782-2688
Mailing Address - Fax:818-782-2777
Practice Address - Street 1:14557 FRIAR ST STUITE #140
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411
Practice Address - Country:US
Practice Address - Phone:818-782-2688
Practice Address - Fax:818-782-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATD0882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD088Medicare ID - Type Unspecified