Provider Demographics
NPI:1275630287
Name:INTIMATE IMAGE NO 1 INC
Entity Type:Organization
Organization Name:INTIMATE IMAGE NO 1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-876-7333
Mailing Address - Street 1:22941 VENTURA BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1242
Mailing Address - Country:US
Mailing Address - Phone:818-876-7333
Mailing Address - Fax:818-876-7334
Practice Address - Street 1:22941 VENTURA BLVD STE M
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1242
Practice Address - Country:US
Practice Address - Phone:818-876-7333
Practice Address - Fax:818-876-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02521FMedicaid
CA4351590001Medicare NSC