Organization
J. BRUCE JACOBS, MD, INC
Active
Other names
WILSHIRE RADIOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER USMANOV M.D. (PRESIDENT)
(213) 487-4077
Entity
Organization
Contact information
Practice address
3055 WILSHIRE BLVD, SUITE150, LOS ANGELES, CA 90010-1108
(213) 487-4077
(213) 487-7517
Mailing address
3055 WILSHIRE BLVD, SUITE150, LOS ANGELES, CA 90010-1108
(213) 487-4077
(213) 487-7517
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A21604
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316240393
—
CA
Enumeration date
12/13/2010
Last updated
01/28/2014
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