1457788630 NPI number — A & G DIAGNOSTICS IMAGING INC

Table of content: MARGARET DRENNON BUTTS RN (NPI 1588373443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457788630 NPI number — A & G DIAGNOSTICS IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A & G DIAGNOSTICS IMAGING INC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1457788630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4343 CRENSHAW BLVD STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90008-4929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-422-6225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 CEDROS AVE UNIT 340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91403-2840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-422-6225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TIKHONOV
Authorized Official First Name:
ALBINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
213-422-6225

Provider Taxonomy Codes

  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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