Organization
HEAD AND NECK IMAGING ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAIRZETTE LAYNE (BILLING MANAGER)
(310) 829-9788
Entity
Organization
Contact information
Practice address
2827 WILSHIRE BLVD, SANTA MONICA, CA 90403-4801
(310) 829-9788
(310) 453-1576
Mailing address
2827 WILSHIRE BLVD, SANTA MONICA, CA 90403-4801
(310) 829-9788
(310) 453-1576
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
W11873
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0071050
—
CA
01
—
ZZZ496712
BLUE SHIELD OF CA
CA
Enumeration date
04/02/2007
Last updated
08/22/2020
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