Provider Demographics
NPI:1891741385
Name:FUBOS IMAGING, INC.
Entity Type:Organization
Organization Name:FUBOS IMAGING, INC.
Other - Org Name:IMPERIAL DIAGNOSTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDRATYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-590-1547
Mailing Address - Street 1:11161 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2336
Mailing Address - Country:US
Mailing Address - Phone:310-590-1547
Mailing Address - Fax:310-590-1546
Practice Address - Street 1:11161 CRENSHAW BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2336
Practice Address - Country:US
Practice Address - Phone:310-590-1547
Practice Address - Fax:310-590-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology