Basic Information
Provider Information | |||||||||
NPI: | 1164697942 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BEVERLY HILLS 3 TESLA IMAGING CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20011 VENTURA BLVD | ||||||||
Address2: | 1002 | ||||||||
City: | WOODLAND HILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 91364 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8187086163 | ||||||||
FaxNumber: | 8183405537 | ||||||||
Practice Location | |||||||||
Address1: | 9134 W OLYMPIC BLVD | ||||||||
Address2: |   | ||||||||
City: | BEVERLY HILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 902123540 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3104321000 | ||||||||
FaxNumber: | 3104324321 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/23/2008 | ||||||||
LastUpdateDate: | 09/26/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TABIBIAN | ||||||||
AuthorizedOfficialFirstName: | BAHRAM | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/ MEDICAL DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 8187086163 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | F&M RADIOLOGY MEDICAL CENTE RINC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | A40559 | CA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.