| NPI | 1679862403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERGO KUTELIA CEO 818-219-7003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Y00000X Otolaryngology |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2011-04-01 |