Provider Demographics
NPI:1780808097
Name:VAL P SHULMAN
Entity type:Organization
Organization Name:VAL P SHULMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-878-2570
Mailing Address - Street 1:7559 SANTA MONICA BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6406
Mailing Address - Country:US
Mailing Address - Phone:323-878-2570
Mailing Address - Fax:323-878-2574
Practice Address - Street 1:7559 SANTA MONICA BLVD # 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-6406
Practice Address - Country:US
Practice Address - Phone:323-878-2570
Practice Address - Fax:323-878-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38820261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056270Medicaid
CA204545OtherFDA #
CA204545OtherFDA #