Provider Demographics
NPI:1942566484
Name:PREMIER DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PREMIER DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YANIV
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBENBLOOMM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-505-0152
Mailing Address - Street 1:20929 VENTURA BLVD
Mailing Address - Street 2:47-350
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2334
Mailing Address - Country:US
Mailing Address - Phone:818-505-0152
Mailing Address - Fax:818-505-0398
Practice Address - Street 1:20929 VENTURA BLVD
Practice Address - Street 2:47-350
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2334
Practice Address - Country:US
Practice Address - Phone:818-505-0152
Practice Address - Fax:818-505-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty