Provider Demographics
NPI:1003342262
Name:MINT SERVICES
Entity type:Organization
Organization Name:MINT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GENNADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SATANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-260-4891
Mailing Address - Street 1:11333 MOORPARK ST # 402
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2618
Mailing Address - Country:US
Mailing Address - Phone:818-623-8100
Mailing Address - Fax:
Practice Address - Street 1:12183 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606
Practice Address - Country:US
Practice Address - Phone:818-623-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical GeneticsGroup - Multi-Specialty