1801907084 NPI number — LIBERTY PACIFIC MEDICAL IMAGING, LLC

Table of content: CINDY ELAYOUBI M.S.ED., BCBA, LBS (NPI 1417465329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801907084 NPI number — LIBERTY PACIFIC MEDICAL IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY PACIFIC MEDICAL IMAGING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801907084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16130 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-933-2020
Provider Business Mailing Address Fax Number:
818-933-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16130 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-933-2020
Provider Business Practice Location Address Fax Number:
818-933-2021
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAVON
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
V.P. MARKETING & PAYER CONTRACTING
Authorized Official Telephone Number:
530-367-5295

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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