# IMAGE M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104978766
- **Authorized official:** DR. CLARENCE SUTTON M.D. (PHYSICIAN OWNER)
- **Authorized official phone:** (818) 506-5906

## Contact information

- **Practice address:** 12805 VICTORY BLVD, N HOLLYWOOD, CA 91606-3012
- **Practice address phone:** (818) 506-5906
- **Mailing address:** 12805 VICTORY BLVD, N HOLLYWOOD, CA 91606-3012
- **Mailing address phone:** (818) 506-5906

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G74582 | CA | Yes |

## Other

- **Enumeration date:** 01/16/2007
- **Last updated:** 08/22/2020